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Alcohol use in a general hospital inpatient population ‘ Hear no evil, see no evil ’ Dr. Kieran O’Loughlin. Background. 1133 admissions in an Irish hospital 30\% of men and 8\% of women met the DSM IV criteria for alcohol abuse or dependence 1 .

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Alcohol use in a general hospital inpatient population ‘Hear no evil, see no evil’ Dr. Kieran O’Loughlin

  • 1133 admissions in an Irish hospital 30% of men and 8% of women met the DSM IV criteria for alcohol abuse or dependence1.
  • For patients attending accident and emergency the figure may be as high as 40%2.
  • Screening and brief interventions have been shown to have beneficial effects with respect to long-term outcome in cases of alcohol misuse3.
  • Hospital-based psychiatric substance use consultations improve engagement in alcohol rehabilitation and treatment outcome4.
In 2006 the Psychiatry of Later Life liaison service in Tallaght Hospital Dublin, received only 8 consultation requests for alcohol misuse (out of a total of 211 requests for psychiatric consultation) representing less than 4% of all referrals.
  • 1.

We aimed to determine if poor documentation of alcohol intake is a problem amongst the NCHD (Non-Consultant Hospital Doctor) population in Tallaght hospital.

  • 2.

We aimed to assess NCHD’s attitudes towards alcohol misuse to determine if there are specific patient variables which may influence the decision to refer to specialist services.

  • 3.

We aimed to assess NCHD’s knowledge of the safe levels of alcohol consumption for both males and females.

  • Part 1 Chart Review
  • Part 2 Questionnaire
    • 1. Give no further advice regarding alcohol intake
    • 2. Advice to cut back on alcohol intake
    • 3. Advice to abstain from further drinking
    • 4. Recommend self-referral to alcohol services
    • 5. Refer to General Practitioner for management
    • 6. Refer to specialist services
  • The differences demonstrated between all three subgroups in Table 1 (medical vs. surgical, male vs. female, >65 vs. <65) are statistically significant (0.02< p < 0.05 in all cases).
  • However the relatively large number patients in the ‘alcohol history but no quantity’ subgroup contributes strongly to the calculation of statistical significance.
implications part 1
Implications – Part 1
  • 62% of patients – Quantity of alcohol consumed not documented.
    • It may represent an attitude amongst NCHDs towards alcohol intake in certain patient populations as defined by age, gender or the nature of presenting complaint.
    • It may represent a lack of awareness on the part of NCHDs as to the importance of taking an alcohol history.
    • It may simply represent a lack of knowledge on the part of NCHDs as to how to take an alcohol history.
results part 2
Results – Part 2
  • Our questionnaire dealt with treatment issues.
  • 2 case vignettes
    • the presenting complaint was consequent upon alcohol misuse
    • Case vignette No. 1: 30%
    • Case vignette No. 5: 78%

(chose option of referral to specialist services)

results part 21
Results – Part 2
  • 4 Case vignettes – P/C not consequent upon alcohol misuse.
  • Case vignette No. 2: 12%.
  • Case vignette No. 3: 8%
  • Case vignette No. 5: 4%
  • Case vignette No. 6: 9%
We must concede that the failure of NCHDs to opt for ‘referral to specialist services’ may also indicate a lack of knowledge as to what services are available to them. To what extent this factor influenced the findings of our study is unclear.
  • 95% of NCHDs correctly identified the recommended weekly limit of alcohol consumption for both women and men (14 units and 21 units respectively).
  • Medical education has been shown to lead to improvements in the detection of alcohol misuse by hospital interns5.
  • This survey clearly identifies a need for further education of NCHDs with regard to the detection of excessive alcohol intake in their patients.
  • Implement educational programme.
  • Complete audit cycle next year.
  • 1. Hearne R, Connolly A, Sheehan J. Alcohol abuse: prevalence and detection in a general hospital. J R Soc Med 2002;95:84-87.
  • 2. Conigrave K, Burns FH, Reznik RB, Saunders JB. Problem drinking in emergency department patients: the scope for early intervention. Med J Aust 1991;154:801-5.
  • 3. . Babor TF, Higgins-Biddle JC, Dauser D, Burleson JA, Zarkin GA, Bray J. Brief interventions for at-risk drinking: patient outcomes and cost-effectiveness in managed care organizations. Alcohol Alcohol. 2006 Nov-Dec;41(6):624-31.
  • 4. Hillman A, McCann B, Walker NP. Specialist alcohol liaison services in general hospitals improve engagement in alcohol rehabilitation and treatment outcome. Health Bull (Edinb). 2001 Nov;59(6);420-3.
  • 5. Gaughwin M, Dodding J, White JM, Ryan P. Changes in alcohol history taking and management of alcohol dependence by interns at the Royal Adelaide Hospital. Med Educ 2000; 34(3):170-4.