Spotlight on SAS

27 May 2022

When St Vincent’s Emergency underwent a full redevelopment in 2020, there were some key elements, both physical and clinical, specifically designed to improve patient flow, comfort, privacy and better outcomes for our patients.

With the State’s highest proportion of vulnerable people presenting to St Vincent’s Emergency, including those presenting with mental ill health, people experiencing homelessness and those using substances, the need to create a safe environment for both these patients and our staff, became a major priority.

As a result, St Vincent’s became the first hospital in the country to open a PANDA Unit. At the same time, St Vincent’s Hospital ED became the only one in the state with a multi-room 6 person Safe Assessment Space (SAS).

But what is SAS? The Safe Assessment Space (SAS), unlike PANDA and PECC, form part of the Emergency Department, and offers a supportive and welcoming environment for people experiencing mental health distress. While PANDA and PECC are collocated within the Emergency Department, they are run operationally, as stand-alone units.

The SAS team includes a specialist psychiatrist and registrar, clinical nurse consultants, social workers and specialised mental health nurses. Following triage and assessment within the SAS, the patient may be admitted to PECC, Caritas or PANDA for further treatment, or even discharged home.

Providing a private space for people who are experiencing suicidality, behavioural disturbance and often times, psychosis, not only affords them with the dignity of being treated away from public view, but it also aims to foster a calmer environment for other patients.

In addition, an unexpected but welcome bonus has been the further level of safety for our staff and other patients.

“The reduction in patient violence is quite a remarkable side effect” said Prof Paul Preisz, Director of Emergency.

With our main goal to adequately treat complex comorbidities, it wasn’t what we set out to achieve. However, given the current rates of violence among this patient cohort, it is certainly something to be celebrated.”

In fact, since the opening of the new dedicated PECC, PANDA and SAS spaces, there has been a 50% reduction in ‘code black’ alerts within the Department. Along with the calm-conducive environment, this reduction can be largely attributed to the dedicated team who have the space and the skills to sit with patients to de-escalate distress, facilitating better outcomes for all.

Psychiatrist Dr Jacqueline Huber is the Clinical Lead for the SAS team and is commencing a research project to look at the benefits, and detractors of these kinds of acute care spaces, so that we can continue to provide evidenced-based, best practise care for our vulnerable patients.
“Having the first of these kinds of services is great, but it also means there is little evidence to guide us”. Dr Huber said.

“Having said that, this appears to be the case within other emergency services both in Australia and abroad. We would be proud if they looked to St Vincent’s to understand the treatment of those in ED experiencing mental ill-health, given the published research in this space is lacking. It’s so important for us to capture real and valuable information that will ultimately help people who are in severe distress”.

On average, the SAS team would care for approx. 200-300 patients each month, 30% of whom need ongoing care, and the numbers are rising.

“To manage the distress of people presenting to ED with mental ill-health, collaboration between ED, Security and the Mental Health teams is the most important ingredient. Collaboration can be difficult when emotions are high, but I couldn’t be prouder of all these teams, who do their best to work together in these busy times”, Dr Huber said.

Watch the full interview with Dr Jacqueline Huber below

Cover image courtesy of The Daily Telegraph/News Corp: Prof Paul Preisz & Dr Jacqueline Huber