Effectiveness of a nurse led hospital in-reach team and assertive follow-up of frequent attenders with alcohol misuse complications – a retrospective mirror image evaluation

Abstract

Purpose– Physical comorbidities of alcohol misuse are common and result in frequent attendance to hospitals with estimated £3.5bn annual cost to the NHS in England. The purpose of this paper is to evaluate the effect of the hospital in-reach team of the Leeds Addiction Unit (LAU) in reducing hospital service utilization in people with alcohol dependence.Design/methodology/approach– This is a retrospective cohort study, with a mirror-image design. The authors included all patients who had wholly alcohol attributable admission(s) to Leeds Teaching NHS Hospitals Trust (LTHT) during a four-month period between January and April 2013 and received treatment from LAU. The primary outcome measures were changes in A and E attendance (A&E) attendances, number of hospital admissions and days spent in hospital between the three months before and after the LAU intervention.Findings– During the four-month period, there were 1,711 wholly alcohol attributable admissions related to 1,145 patients. LAU saw 265 patients out of them 49 who had wholly alcohol attributable admissions engaged in treatment with LAU. Of those who engaged 33 (67.3 per cent) had fewer A&E attendances, 34 (69.4 per cent) had fewer admissions and 39 (80 per cent) spent fewer days in hospital in the three months after compared to three months before. There was a significant reduction in total number of hospital admissions (78 vs 41, mean=1.56 vs 0.82,p<0.001) and days spent in hospital (490 vs 146, mean=9.8 vs 2.92,p<0.001).Originality/value– This mirror-image study suggests that an alcohol hospital in-reach team could be effective in reducing acute hospital service utilization by engaging with the frequent attenders with alcohol misuse complications.