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Hospital Alcohol Project James Crosbie, Gastroenterologist Alcohol Delivery Group 1 st July 2011
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Hospital Alcohol Project James Crosbie, Gastroenterologist Alcohol Delivery Group 1 st July 2011
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Hospital Alcohol Project James Crosbie, Gastroenterologist Alcohol Delivery Group 1 st July 2011. Hospital Alcohol Project James Crosbie, Gastroenterologist Alcohol Delivery Group 1 st July 2011. Hospital Alcohol Project. Background Objectives Personnel Activity & outcomes - PowerPoint PPT Presentation
Transcript of Hospital Alcohol Project James Crosbie, Gastroenterologist Alcohol Delivery Group 1 st July 2011
Hospital Alcohol ProjectJames Crosbie, Gastroenterologist
Alcohol Delivery Group 1st July 2011
Hospital Alcohol ProjectJames Crosbie, Gastroenterologist
Alcohol Delivery Group 1st July 2011
Hospital Alcohol Project
• Background• Objectives• Personnel
• Activity & outcomes– 1. Emergency Dept– 2. Gastroenterology– 3. Turning Point
• The way forward (& barriers)
RPIWSarah Fox & Ben Seale
Background
National Indicator 39 (NI 39)
• Measures rate of alcohol related admissions using Hospital Episodes Statistics (HES)
• “Alcohol Attributable Fractions” for medical conditions applied to HES
• 47 conditions : – 13 wholly attributable conditions– 22 partially attributable chronic conditions– 2 partially attributable acute consequences. – eg ALD =1, hypertension <1 (depending on age & sex)...
• 60-70% NI39 admissions in NE “partially attributable”
National Indicator 39 (NI 39)
• Measures rate of alcohol related admissions using Hospital Episodes Statistics (HES)
• “Alcohol Attributable Fractions” for medical conditions applied to HES
• 47 conditions : – 13 wholly attributable conditions– 22 partially attributable chronic conditions– 2 partially attributable acute consequences. – eg ALD =1, hypertension <1 (depending on age & sex)...
• 60-70% NI39 admissions in NE “partially attributable”
Objective
• Reduce Alcohol Related Hospital admissions (NI39?)
• Increase hospital based resources for patients with alcohol related illness
• Alcohol Steering group
CHS Personnel• Emergency Dept
– Kate Lambert ED Consultant– Cain Thomason Data manager
• Gastroenterology– James Crosbie Clinical Lead– Deb Smith Alcohol Specialist Nurse
• Turning Point– Geoff Anderson Senior Alcohol Worker– Laura Thubrun Alcohol Worker– Tracey Stewart Alcohol Worker
1. Emergency Department
1. Emergency DepartmentThe Scale of the Problem:
• April 2009 – March 2011
– 9150 Alcohol related ED attendances
– 1337 Alcohol related admissions via ED– 269 of these readmissions by 136 individuals
• June 2010 – May 2011
– Top 50 attendees accounted for 598 attendances– Top 10 attendees accounted for 328 attendances
1. Emergency DepartmentThe Scale of the Problem:
• April 2009 – March 2011
– 9150 Alcohol related ED attendances
– 1337 Alcohol related admissions via ED– 269 of these readmissions by 136 individuals
• June 2010 – May 2011
– Top 50 attendees accounted for 598 attendances– Top 10 attendees accounted for 328 attendances
Year 1 of the Hospital Alcohol Project 2009/10 – 2010/11:
– Total ED attendances increased by 1%
– Alcohol related attendances fell by 8%(10% men 5% women)
– Alcohol % total attendances fell by 0.66%
Heavy Service Users Group• Initial activity stopped due to info sharing barriers• Restarting following RPIW
– Info sharing protocol v5.1– Care Navigator post
• Top 20 frequent attenders & others from ED dashboard (or if complex needs identified)
– Kate Lambert -Probation– Data manager -Mental Health– ASN -Housing– DAT -C4
Heavy Service Users Group• Initial activity stopped due to info sharing barriers• Restarting following RPIW
– Info sharing protocol v5.1– Care Navigator post
• Top 20 frequent attenders & others from ED dashboard (or if complex needs identified)
– Kate Lambert -Probation– Data manager -Mental Health– ASN -Housing– DAT -C4– James Crosbie -GP
Youth Drug and Alcohol Project
• Service reinstated with permanent Hospital Link Worker March 2011• 36 alcohol related ED attendances < 18 since then (2.25 /week)• Age range 10 – 17 years (median 15 mean 14)
• 19 referred to YDAP– 10 attended Brief Intervention– 3 sent information packs– 2 already known to YDAP, – 2 open referrals to YDAP– 2 declined any input.
• Of the 17 not referred, 13 have been sent letters from YDAP offering follow up and information packs.
BREAK
2. Gastroenterology
2. Gastroenterology
• Alcohol Specialist Nurse (ASN)
• Introduction of symptom triggered detox
• Alcohol IBA training– Targeted clinical areas & staff– Embedded in junior doctor teaching programme– SASQ embedded in medical admission proforma
Alcohol Specialist Nurse– Inpatient referrals: harmful drinkers
– Liaison with :• Gastroenterology• Community team (Counted 4)• Turning Point• DAT• Other agencies
– Facilitate discharge of gastro patients through early follow up
– Phoneline, voicemail & bleep for direct patient access
– Clinic for review of discharged patients, direct access and scheduled follow up
– Day case paracentesis service with view to nurse led service
– Nurse prescribing
– Alcohol Link Nurse Network (all wards)
A&E
Turning Point
Counted 4
Primary careGastroenterology
Hospital wards
Drug & Alcohol Team
Deb SmithA L N
NeRAF
NECA
Alcohol Specialist Nurse
Activity Jan 2011 – (mid) June 2011
• 392 referrals (70 / month)• Onward Referrals:
– TP: 122 C4: 7 DAT: 17– Housing: 17 Other:29 Huntercoombe: 8
• 285 clinic follow up• 165 BI• 161 liver disease blood tests + 38 liver USS• 128 telephone referrals (56 onward referral / discussion• Direct access paracentesis 26
Alcohol Specialist Nurse
Profile
Staff Education & Training
• Alcohol Link Nurse network
• Nursing Clinical skills
• Medical students
• Hospital meetings
Inpatient detox
• Previous model: Fixed dose detox– 5-7 day admission with controlled reduction– Standard dosing to all “increasing risk” drinkers
• Symptom triggered detox (NICE recommended)– Identify dependence (withdrawal)– Reduce LOS for those not requiring treatment– Increased monitoring & treatment for withdrawal– Reduction in overall drug dispensing & cost– Increased effectiveness of treatment when needed
CIWA-Ar for the management of Alcohol Withdrawal SyndromePatient name______________________ X number_________________________Date started______________________ Time (24hour)_____________________
Pre CIWA (baseline) audit
June – August 2010
• 239 admissions for 194 unique patients• 26 (13%) had been admitted >1 occassion (group A)
Group A Group BAverage total amount per patient (mg) 258.99 213.76Average Daily Amount (mg) 47.93 31.020-24 hours (mg) 89.82 78.5824-48 hours(mg) 87.38 77.7648 hours +(mg) 198.25 213.49
Average amount of chlordiazepoxide used during admission from both single admission (group B) and repeat admission (group A) patients
Pre CIWA (baseline) audit
June – August 2010
• 239 admissions for 194 unique patients• 26 (13%) had been admitted >1 occassion
Repeat Patients
Single Admission patients
Total Admissions 70 168Number of Patients 26 168Average length of stay (days) 4.27 6.83Range (days) 0-20 0-78
number of admissions and average length of stay of both repeat and single admission patients.
Turning Point
Turning Point• All inpatients & A&E attendances identified as problem drinkers
• Monday to Saturday service (diary appointment if intoxicated or out of hours)
• Delivery of alcohol interventions
• Initial assessment with onward referral to community services:– NeRAF– NECCA– Drug & Alcohol Team– Counted 4
Turning Point
February 2011
No of Referrals 80 Assessed 10 Brief Interventions 69 Declined Service 1 Previously Assessed 18
January 2011
No of Referrals 80 Assessed 12 Brief Interventions 65
Declined Service 3 Previously Assessed 29
March 2011
No of Referrals 58 Assessed 18Brief Interventions 40 Previously Assessed
April 2011
No of Referrals 64
Assessed and Referred On 8
Assessed and Taken Onto Caseload 6
Extended Brief Intervention Only 42
Out of Area Referrals 8
Follow Up Appointments 24
December 2010
No of Referrals 66 Assessed 54Brief Interventions 12 Previously Assessed 25
Turning Point
February 2011
No of Referrals 80 Assessed 10 Brief Interventions 69 Declined Service 1 Previously Assessed 18
January 2011
No of Referrals 80 Assessed 12 Brief Interventions 65
Declined Service 3 Previously Assessed 29
March 2011
No of Referrals 58 Assessed 18Brief Interventions 40 Previously Assessed
April 2011
No of Referrals 64
Assessed and Referred On 8
Assessed and Taken Onto Caseload 6
Extended Brief Intervention Only 42
Out of Area Referrals 8
Follow Up Appointments 24
December 2010
No of Referrals 66 Assessed 54Brief Interventions 12 Previously Assessed 25
Turning Point April 2011Gender
Male 40 62.5%Female 24 37.5%
Age
18-24 1 1.6%55-64 8 12.5%
25-34 16 25.0%65-74 3 4.7%
35-44 20 31.3%75+ 3 4.7%
45-54 13 20.3% 0.0%
Ethnicity
White British 63 98.4%Other White 1 1.6%
Accommodation
Hostel 4 6.3%Owned 9 14.1%
Parental 6 9.4%Rented - Gentoo 20 31.3%
Rented - Private 15 23.4%Rented - RSL 7 10.9%
Sheltered Accommodation 1 1.6%Supported Housing 2 3.1%
Postcode
SR1 5 7.8%DH3 1 1.6%
SR2 8 12.5%DH4 3 4.7%
SR3 6 9.4%DH5 7 10.9%
SR4 6 9.4%NE37 1 1.6%
SR5 11 17.2%NE38 3 4.7%
SR6 4 6.3%TS8 1 1.6%
SR7 7 10.9% 0.0%
SR8 1 1.6% 0.0%
Level of Alcohol Use
Abstinent 3 4.7%Harmful 13 20.3%
Binge 13 20.3%Hazardous 2 3.1%
Dependent 29 45.3%Sensible 4 6.3%
Complex Needs
None 6 9.4%Medium 12 18.8%
Low 34 53.1%High 12 18.8%
Children
Parent/Childcare Responsibilities 24 37.5%Children Living in Property 7 10.9%
Armed Forces
Yes 0 0.0%Forces Attributable? 0 0.0%
No 63 98.4%
Referral Source
A&E 2 3.1%Alcohol Nurse 7 10.9%
AMU 3 4.7%ASN 1 1.6%
B28 2 3.1%C33 1 1.6%
C36 37 57.8%ESAU 1 1.6%
D57 1 1.6%F51 1 1.6%
Self 6 9.4%Self Harm Team 2 3.1%
Referrals Made
AA 1 1.6%Counted 4 1 1.6%
Cruise 1 1.6%Dual Diagnosis Nurse 2 3.1%
Durham CAS 5 7.8%NECA 5 7.8%
NERAF 1 1.6%Self Harm Team 1 1.6%
Presenting Complaints
Abdominal Pain 3 4.7%Alcohol Excess 1 1.6%
Alcohol Withdrawal 5 7.8%Assaulted 1 1.6%
Cellulitis 2 3.1%Chest Pain 2 3.1%
Collapsed 2 3.1%Depression 1 1.6%
Fall 8 12.5%Generally Unwell 1 1.6%
Overdose 12 18.8%Self Harm 5 7.8%
Stomach Cancer 1 1.6%Stroke 1 1.6%
Suicidal Ideation 9 14.1%Vomiting 2 3.1%
N/A 8 12.5% 0.0%
The way forward• Implement RPIW outcomes
– Care Navigator– Enhanced data set & data management– 7 day alcohol liaison service
• Roll out CIWA across all (non medical) wards– Complete audit (post CIWA)
• Enhanced ASN role including– Increased outpatient capacity– Prescribing role– Further bid for additional post (readmission funds)
Barriers
Barriers
• NI39– Unresponsive (majority partially attributable)– Newcastle model: wholly attributable analysis
