Ministerial Direction - Crisis Care Process

QH-MD-001

Authority

In accordance with s 44(1) of the Hospital and Health Boards Act 2011, I am satisfied it is necessary in the public interest that I give this written direction to the Hospital and Health Services listed below, under ‘Scope’ with immediate effect.

Commencement

This Ministerial Direction is intended to operate from and including 17 November 2023.

Purpose

This Ministerial Direction implements a ‘Crisis Care Process’ in Hospital and Health Services which are responsible for Emergency Departments in specified Hospitals. The crisis care process will require the relevant Hospital and Health Service to accept care and commence an approved Clinical Care Pathway for any person who attends at an Emergency Department and discloses having experienced sexual assault, or is presented by an officer of the Queensland Police Service as a victim of a sexual assault, within 10 minutes of the disclosure or presentation.

This Ministerial Direction operates in tandem with Health Service Directive ‘Caring for people disclosing sexual assault’ [QH-HSD-051 (V2)].

Scope

This directive applies to Hospital and Health Services (HHSs) which are responsible for the following Emergency Departments (EDs) and applies specifically to the following EDs:

Outcomes

HHSs included in the scope of this directive shall:

• Implement a Crisis Care Process in EDs, which requires that any person who discloses a sexual assault during a presentation, or is presented by an officer of the Queensland Police Service (a police officer) as a victim of a sexual assault, must:
  • be accepted into care by the HHS; and
  • be commenced on the HHS’s Clinical Care Pathway within 10 minutes of the disclosure or presentation.

If the HHS is unable to commence its Clinical Care Pathway within the above timeframe due to genuine operational or clinical needs, the Clinical Care Pathway shall be commenced at the earliest opportunity.

• Take responsibility for the care of the person from the time they present to the ED, through their Clinical Care Pathway, including performing a Forensic Medical Examination (in accordance with the Health Service Directive ‘Caring for people disclosing sexual assault’ [QH-HSD-051 (V2)]), if the person chooses to have this.

Forensic Medical Examinations can be provided by:

• Forensic Physician
• Medical Officers who have received training in sexual assault examination
• Medical Officers (not including interns) accessing phone support from Forensic Medicine Qld
• Forensic Nurse Examiners
• Sexual Assault Nurse Examiners and Nurse Practitioners who have received additional training in sexual assault examination.

If an exceptional circumstance arises where a hospital transfer is required, the Clinical Care Pathway must ensure that the person is supported in a trauma informed way throughout the entire process.

The Crisis Care Process

There will be a crisis care process in the EDs specified in this Ministerial Direction.

Any HHS to which this Ministerial Direction applies must accept into immediate care any person who discloses a sexual assault during a presentation at an ED, or who is presented to an ED by a police officer as a victim of a sexual assault.

The HHS will ensure that any person who discloses a sexual assault during a presentation, or is presented by a police officer as a victim of a sexual assault, is commenced on the HHS’s Clinical Care Pathway within 10 minutes of the presentation or disclosure.

However, a HHS will not fail to comply with this Ministerial Direction if, having regard to genuine operational or clinical needs, the HHS was unable to commence its Clinical Care Pathway within 10 minutes of the disclosure or presentation.

Genuine operational or clinical needs include:

• a need to provide urgent or high priority medical care to the person disclosing a sexual assault or another patient or patients; and/or
• an unplanned absence of staff, including due to a need to provide urgent or high priority medical care to another patient.

In reaching a view as to whether there are genuine operational or clinical needs which prevent the HHS commencing the applicable pathway within 10 minutes of the disclosure or presentation, clinical judgment may be taken into account.

If a HHS is unable to commence its Clinical Care Pathway in respect of the victim of assault within 10 minutes of the disclosure or presentation, that HHS must take all reasonable steps to commence the Clinical Care Pathway at the earliest opportunity.

If an exceptional circumstance arises where a hospital transfer is required, the Clinical Care Pathway must ensure that the person is supported in a trauma informed way throughout the entire process.

A HHS must record the following, at the earliest opportunity, in respect of any disclosure or presentation within the meaning of this Ministerial Direction:

• whether the person was accepted into care immediately; and
• whether the person was commenced on its Clinical Care Pathway within 10 minutes.

If the person was not accepted into care immediately, or if a Clinical Care Pathway was not commenced within 10 minutes, a HHS must:

• record the timeframe in which the person was accepted into care, and in which the Clinical Care Pathway was commenced;
• record the genuine operational or clinical needs which prevented the HHS from commencing its Clinical Care Pathway within 10 minutes; and
• disclose to an appropriate officer of the Office of the Chief Medical Officer, in a manner which does not identify the victim, of the delay, of the extent of the delay, and of the genuine operational or clinical need recorded.

Given by the Honorable Shannon Fentiman MP, Minister for Health, Mental Health and Ambulance Services, Minister for Women, Member for Waterford

Date: 17 November 2023