A recent initiative at Hervey Bay Hospital is helping to better understand and address the factors contributing to patients leaving the Emergency Department (ED) before completing their care.
The focus has been on strengthening cultural safety and improving support for Aboriginal and Torres Strait Islander patients, with promising results.
The project, led by Aboriginal and Torres Strait Islander Hospital Liaison Officer Portia Walters, explored the broader social, emotional, and cultural influences that can contribute to Discharge Against Medical Advice (DAMA) decisions.
“Choosing to leave early isn’t about rejecting care,” Portia said.
“Often, it’s about balancing competing responsibilities needing to collect children from school, not having essential items at home, or not feeling culturally or emotionally safe in a clinical setting.”
Themes emerging from the research included long wait times, family and community responsibilities, and emotional distress. Parents arriving with children, particularly those with additional needs, may experience added stress in crowded or unfamiliar environments.
“Feeling understood and supported can make a big difference,” she said.
"We have seen that having an Aboriginal and Torres Strait Islander Health Worker present, not just in the Emergency Department but across the entire hospital helps reduce anxiety, build trust, and support culturally appropriate communication throughout the patient journey.”
The project data showed a clear reduction in DAMA rates during shifts when Aboriginal and Torres Strait Islander Health Workers were on duty, highlighting their vital role in supporting patient engagement.
Senior Health Worker Jillanne Weyman expressed her gratitude for the growing collaboration between the ED and the Aboriginal and Torres Strait Islander health team.
“There’s been a real shift,” she said.
“Staff across the board – nurses, doctors, admin – are working more closely with us.
"There’s more respect, better communication, and patients are noticing the difference.”
The project team hopes these findings will support ongoing investment in culturally safe care models and further recognition of the frontline role Aboriginal and Torres Strait Islander Health Workers play in improving patient outcomes.
“As much as clinical care is critical, so is the need for patients to feel safe, respected and heard,” Portia said.
“When that happens, people are more likely to stay and receive the care they need.”