Identifying Patients with ARLD on the Isle of Wight Dr Leonie Grellier Consultant Gastroenterologist

Isle of Wight

• Population 140 500

• Socially deprived rural population – Ryde, Newport, Ventnor

• 24% aged 65 or above

• One acute trust with 246 beds, 22000 admissions/yr

• At least 10000 adults drinking at increased risk levels

• Evidence for significant under age drinking

Current provision for alcohol services

Community treatment –

Butler Gardens 70/yr

GP surgeries

?

Patient self

referral

IRIS community

3WTE band 4/5/6 800/yr

St Mary’s No alcohol

team 1 consultant

Small numbers of patients with MH problems treated in Sevenacres

Headline numbers: Isle of Wight NHS Trust (AHSN data)

• During Jan 2011 – Dec 2015:

– There were 1,652 LD admissions

– There were 535 ARLD admissions (from 272 ARLD patients)

– 36 % of all LD admissions had an alcohol-specific condition recorded

– 92 % of all LD admissions were emergency

– 47% ARLD group died in hospital (39% non ARLD)

* Cost may be under-reported by up to 10%, as some admissions could not be assigned to a HRG tariff 4

Liver Disease/ARLD inpatient journey St Mary’s IOW (2014-2015)

Key Narrative

This visualisation shows the routes of admission for Liver Disease and ARLD through wards at the Trust.

204 patients were admitted to surgical wards

In depth audit of admissions reveals an additional 27% of patients with non ARLD codes have evidence for

ARLD

Method of Admission

Admitting ward

ARLD/non-ARLD

admission

5

IOW ARLD baseline audit

• Retrospective audit of acute admissions Jan-March 2015 to St Mary’s Hospital, Newport.

• Undertaken by 2 CT2 and I SpR

• Using WAHSN audit tool template

• 61 sets of notes reviewed

IOW ARLD baseline audit 2015

Disease Group Number of patients

Asked about alcohol intake (%)

Quantifiable alcohol intake (%)

Audit C completed (%)

ARLD 20 85 26 0

Alcohol group 26 77 29 0

Other LD 15 73 9 0

Total 61 79 24 0

IOW ARLD baseline audit 2015

Disease Group

Number of patients

Patients seen by AIT

% given brief advice

% offered community alcohol team ref

% patients offered other support (OPA)

ARLD 20 0 16 20 20

Alcohol group 26 0 0 15 23

Other LD 15 0 0 7 0

Total 61 0 5 15 16

IOW ARLD baseline audit 2015

• 15 patients coded as ‘other liver disease’

• 5 had direct or indirect evidence of ARLD

• Anecdotal evidence of referral to community services ineffective

‘I can do it on my own’

Moving forward

• September 2016 baseline audit complete

• October – February 2016 – Stakeholder meetings CCG, PH, IRIS, Trust

CEO/MD

– Business case for inpatient team in development

– Training of front line staff in alcohol screening

– Audit of uptake of AUDIT C and CIWA in MAAU

– Presentation of results to ED / development of screening

Moving forward

– Presentation at clinical standards group AUDIT C/ CIWA to adopt as standard screening tools

– Development of research project using community pharmacies to screen and refer (more later)

– Plans for integrated alcohol service presented at JCB CCG 1st February

– Re audit planned Jan- March 2018

Integrated alcohol team

Community treatment clinics nurse/consultant

Pharmacies

Universal screening

GP surgeries

Universal screening

Patient self

referral

IRIS Team manager

–band 6/7 2WTE band 4/5 2WTE band 4/5

St Mary’s 2 WTE band 6/7

Admin 0.5 1WTE band 4,

Consultant 1 PA (Pharmacy) technicians)

Nurses work between locations to provide 7/7 daytime service

Barriers to Improvement

• Start up costs of hospital and community teams