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Special unit not a 'drunk tank'
Name reflects a more respectful attitude
Like many EDs, the one at Norwalk (CT) Hospital has an isolated room to the rear of the department where intoxicated people are brought to sober up. But don't you dare call it a "drunk tank."
Connecticut state law is the reason that this state might be ahead of the rest of the nation in having EDs manage intoxicated patients. By Connecticut law, no person can be incarcerated if they have a blood level over a minimum limit. If he/she does, monitoring and testing must be performed in an ED until the blood alcohol value falls below the legal limit. This law results in a larger number of intoxicated patients in the ED than in other states without such a law.
"We changed the name to Behavior Control Unit when we built our new ED several years ago," says Michael Carius, MD, FACEP, chairman of the Department of Emergency Medicine. The unit is not just for intoxicated patients, Carius says. They might be psychiatrically compromised individuals who require ongoing supervision. "It also removes the stigma of 'drunks' and simplistic attempts to categorize people," he adds.
The unit is located in a "pocket" behind the nurses' station, says Carius. "It's sort of like a dorm room," he explains. "On the far wall are three bays separated by a curtain, and each bay has a stretcher in it." In the far left corner is a bathroom with a shower, and on the near wall on the left-hand side are two more bays with two stretchers separated by curtains, he adds. "On the right is a single enclosed room with blinds for someone who really needs seclusion and the elimination of all visual and auditory stimuli," Carius notes.
Of course, safety is a major concern. Lorraine Salavec, MS, RN, CEN, service line director for the ED, says, "The room has safety curtains. If you yank on them, they come right down. The bathroom has to have toilets and sinks affixed to the wall, so nothing can be pulled off the wall and used as a weapon." There are no plastic bags in the unit just linens, she adds. There is also emergency equipment such as oxygen and suction devices in the safety panel.
Originally, says Carius, patients were sent directly to the unit depending on arrival mode, such as by police or ambulance, but it was learned that some people were being sent inappropriately who might not be medically stable. "Now, every patient who comes in needs to be evaluated and medically cleared and then sent there," he says. Medical clearance is up to the ED physician, Carius notes. "The typical patient is someone who comes in intoxicated on alcohol, is at least arousable, may have some slurred speech, and has no signs of significant trauma, such as a compromised airway or abnormal vital signs," he explains. "They go there to be monitored until he or she has sobered up."
While in the unit, patients are monitored by a "sitter," a non-medical person hired by the hospital. They have no professional responsibility, but they will report any potential problems. "They will report it right to the charge nurse," says Salavec. "There is also a panic button, in case somebody is very violent and you need help quickly from security."
If patients start to act out but are not an immediate threat, an ED staff member will address them and let them know "they have a very small opportunity to correct," Salavec says. "If they do not, you bring them into the main ED where they can be observed and have more intensive nursing care."
For more information on separate units for intoxicated patients, contact:
Behavioral unit helps staff
The Behavioral Control Unit behind the ED at Norwalk (CT) Hospital does more than provide a service for intoxicated patients. It provides benefits for the ED staff and patients in the main unit as well.
"It gives you additional space," notes Lorraine Salavec, MS, RN, CEN, service line director for the ED. "We're often short on space in the ED. It also segregates these patients from the rest of the patients, which is important because we are a community hospital, so we see children people of all ages." It would "not be too pleasant," she notes, to have a 7-year-old in the ED next door to a drunken person who is acting out.
Basically, the unit provides these individuals a place to sober up, Salavec says. Staff members provide minimal care for them, she says.
Once these patients are sober, they are discharged just like any other ED patient, says Michael Carius, MD, FACEP, chairman of the Department of Emergency Medicine. "The only exceptions would be if, for example, they say that they'd like to go through an active detox program, or they say they've really been depressed and have been thinking about hurting themselves and would like to talk to a counselor or doctor," Carius says. "At that point, we would get a psych consult."