A 3-year experience of an Australian short-stay Psychiatric, Alcohol and Non-prescription Drug Assessment Unit: unit...

The Psychiatric, Alcohol and Non-Prescription Drug Assessment (PANDA) Unit was opened at St Vincent's Hospital Sydney in 2020 to provide short-stay medical monitoring and care for people presenting to the emergency department with alcohol or other drug intoxication or behavioural disturbance with co-existing general medical, drug and alcohol and/or mental health issues. The aim of this study was to describe the activity of the PANDA Unit across the first 3 years of operation and explore patient experience.

A mixed methods design was used. A retrospective record review (2020-2023) captured patient demographics, admission characteristics and discharge disposition. Brief, structured interviews were conducted with PANDA patients to explore their admission experience, including the care provided. Interviews were analysed using an inductive approach to develop themes.

2473 patients had 4108 admissions to PANDA, median 333 (range, 296-396) admissions per quarter. Median patient age was 40 (range, 16-93) years, most (64.5%) were male and 11.2% had 'no-fixed abode' documented. Most admissions were associated with alcohol and stimulant intoxication and/or suicidality. Median PANDA length of stay was 21.2 hours (range, 0.5-883.1); 20% of admissions were >48 hours. Most patients (83.8%) were discharged from PANDA to their usual place of residence, 4.9% self-discharged and 15% were readmitted to PANDA within 28 days of discharge, 56 people were readmitted three or more times. The experiences of interview participants (n=14) regarding the PANDA Unit was described by three key themes: (1) patients receive non-judgemental, whole-person care from a large multidisciplinary team, (2) PANDA provides a transition point to further care and (3) PANDA is a comfortable and busy space.

PANDA provided tailored care in a short-stay context for people presenting to emergency department with complex comorbidities. Its unique model of care addressed barriers to healthcare access, such as stigma and siloed care.