Supporting equitable care of patients transferred from police watch-houses to the emergency department: A qualitative study of the perspectives of emergency doctors.

OBJECTIVE: People detained in short-term police custody often have complex health conditions that may necessitate emergency care, yet little is known about their management in EDs. The present study aimed to understand ED doctors' experiences and perceptions regarding the appropriateness and management of detainee transfers from police watch-houses to the EDs. METHODS: A qualitative descriptive study, using semi-structured interviews undertaken with ED doctors working in five purposively sampled EDs across Queensland, Australia. Data were analysed using inductive content analysis. RESULTS: Fifteen ED specialists and trainees participated. Participants reported that their overarching approach was to provide equitable care for watch-house detainees, as they would for any patient. This equitable approach needed to be responsive to complicating factors common to this population, including presence of police guards; restraints; complexity (physical/mental/social) of presentation; reliance on police to transport; ED doctors' often limited understanding of the watch-house environment; justice processes and uncertain legal disposition; communication with the watch-house; and detainees misreporting symptoms. Thresholds for assessment and treatment of detainees were contextualised to the needs of the patient, ED environment, and imperatives of other relevant agencies (e.g. police). Participants often relied on existing strategies to deliver quality care despite challenges, but also identified a need for additional strategies, including education for ED staff; improved communication with watch-houses; standardised paperwork; extended models of watch-house healthcare; and integrated medical records. CONCLUSIONS: Providing equitable healthcare to patients transported from watch-houses to the EDs is challenging but essential. Numerous opportunities exist to enhance the delivery of optimal care for this underserved population.

Paravertebral bronchogenic cyst diagnosed by computed tomography-guided biopsy.

Bronchogenic cysts are lesions that are an anomaly of congenital development. Although most are found in the mediastinum, bronchogenic cysts can be found in many different anatomical positions in the body and can have multiple presentations. These lesions can be asymptomatic and found incidentally, or they can present with specific symptoms. Bronchogenic cysts can be diagnosed on multiple radiographic modalities including conventional radiography, computed tomography, and magnetic resonance imaging. Most are treated conservatively but the possibility of infection or malignant transformation has caused some clinicians to recommend invasive treatment for these lesions. This article presents a case report of the diagnosis and management of a paravertebral bronchogenic cyst in a 64-year-old female.