158: Social Worker Intervention for Detoxification Referral and Rate of Recurrence of Acute Alcohol- Intoxicated Patients Presenting to the Emergency Department

Abstract

Recurrent emergency department (ED) visits for acute alcohol intoxication are common requiring utilization of various resources. In the ED at our institution, social worker intervention (SWI) provides referral for outpatient detoxification (detox) services. This study was conducted to determine the rate of recurrence of acute alcohol intoxicated (AAI) patient visits presenting to the emergency department and to evaluate the success of SWI for an outpatient detox program referral and treatment. We used an observational retrospective cohort design in the setting of an inner city teaching hospital to study AAI patients visiting the ED from June 2008 to May 2009. Patients were included if they were over 18 years, had Medicaid insurance, a primary ED diagnosis related to AAI and were not hospitalized. We reviewed the records to determine the following: age, sex, total number of alcohol related visits, if the patient received a SWI and whether or not the patient went to a detox program. For purposes of this study, 2 or more ED visits for an AAI was considered a recurrence and 4 or more visits to the ED for AAI was considered chronic recurrence. A total of 40 patients were identified. The mean age of the population studied was 46.35 years (95%CI 43.51 - 49.19). 30/40 (75%) were male and 10/40 (25%) were female. There was a total number of 265 ED visits. The mean number of visits was 6.98 (95%CI 3.72 - 10.23). Recurrent visits of 2 or more was seen in 28/40 (70%) patients. Chronic recurrence of 4 or more visits was seen in 16/40 (40%) patients. SWI was received on 201/265 visits (75.8%) and on the rest of the visits 64/265 (24.2%) the patient either refused SWI or left before SWI. On the majority of visits 240/265 (90.6%) patients did not go to detox treatment. Detox was obtained on 21/265 (7.9%) visits and unknown in 4/265 (1.5%) visits. A multilinear regression analysis was used to compare those visits where detox was obtained and SWI and no correlation was found. (p = 0.47) In addition, there was no correlation found when comparing went to detox with respect to age (p = 0.58), sex (p = 0.63) and total number of AAI patient ED visits (p = 0.76). The mean number of visits of AAI patients was just about 7 per year. In addition, recurrence is an issue with 2 or more ED visits for AAI being seen in 70% of patients and chronic recurrence being indicated in 40% of patients who had 4 or more ED visits for AAI. More importantly, in this study, since no correlation was shown between SWI and detox, SWI alone was not effective for ensuring that AAI patients receive outpatient detox treatment. This warrants continued further investigation on ways to better utilize ED resources as well as social services for these AAI patients to facilitate improved compliance with going to an outpatient detox program.