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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 James Crosbie, Gastroenterologist Alcohol Delivery Group 1 st July 2011. Hospital Alcohol Project. Background Objectives Personnel Activity & outcomes

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Hospital Alcohol Project James Crosbie, Gastroenterologist Alcohol Delivery Group 1 st July 2011

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  1. Hospital Alcohol ProjectJames Crosbie, GastroenterologistAlcohol Delivery Group 1st July 2011

  2. Hospital Alcohol ProjectJames Crosbie, GastroenterologistAlcohol Delivery Group 1st July 2011

  3. Hospital Alcohol Project • Background • Objectives • Personnel • Activity & outcomes • 1. Emergency Dept • 2. Gastroenterology • 3. Turning Point • The way forward (& barriers)

  4. RPIWSarah Fox & Ben Seale

  5. Background

  6. 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”

  7. 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”

  8. Objective • Reduce Alcohol Related Hospital admissions (NI39?) • Increase hospital based resources for patients with alcohol related illness • Alcohol Steering group

  9. 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

  10. 1. Emergency Department

  11. 1. Emergency Department The 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

  12. 1. Emergency Department The 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

  13. 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%

  14. 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

  15. 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

  16. 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.

  17. BREAK

  18. 2. Gastroenterology

  19. 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

  20. 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)

  21. NeRAF NECA

  22. 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

  23. Alcohol Specialist Nurse

  24. Profile

  25. Staff Education & Training • Alcohol Link Nurse network • Nursing Clinical skills • Medical students • Hospital meetings

  26. 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

  27. CIWA-Ar for the management of Alcohol Withdrawal Syndrome Patient name______________________ X number_________________________ Date started______________________ Time (24hour)_____________________

  28. Pre CIWA (baseline) audit June – August 2010 • 239 admissions for 194 unique patients • 26 (13%) had been admitted >1 occassion (group A) Average amount of chlordiazepoxide used during admission from both single admission (group B) and repeat admission (group A) patients

  29. Pre CIWA (baseline) audit June – August 2010 • 239 admissions for 194 unique patients • 26 (13%) had been admitted >1 occassion number of admissions and average length of stay of both repeat and single admission patients.

  30. Turning Point

  31. 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

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