Management of intoxicated young people in the Emergency Department: results from a pan-London service evaluation

Abstract

<h3>Aims</h3> Each year approximately 65,000 young people present to Emergency Departments (ED) as a result of alcohol intoxication. There is a large body of evidence in the written literature, detailing ways in which ED9s can use these presentations to help identify young people in need and intervene to reduce future alcohol related presentations. We performed a service evaluation to explore how EDs in London determine if a young person presenting intoxicated is at risk from their drinking, or drinking because of other co-morbidities, and what interventions are available to support the young person. We asked the paediatric lead for each of the 32 ED9s in the Greater London area to complete a short paper questionnaire. We hypothesised that the 16-17 year old group may be particularly at risk due to age thresholds between paediatric and adult services, and specifically asked questions to assess this risk. <h3>Results</h3> 22/32 ED9s completed the questionnaire (69%). <h3>Assessment of risk</h3> Alcohol screening tools were more common in adults (55%) than children under 16 (9%). Structured psychosocial histories were routinely taken in 7% units. <h3>Safeguarding practices</h3> 41% of ED9s always discuss patients under 16 in safeguarding meetings compared to 23% for patients aged 16-17 years. For under 169s, 71% of ED9s shared information with the patients GP, compared to 64% for 16-179s. For patients less than 16, 71% shared information with school nurses; 43% for those 16-17. <h3>Treatment/support</h3> Information about alcohol services was available in 73% ED9s. Referral pathways to drug and alcohol services were similar between adults and young people, 41-45%. <h3>Conclusion</h3> There appears to be inadequate screening and discussion of young people who present intoxicated to the ED and vulnerable young people could be missed. In particular we noted that the 16-17 age groups are potentially vulnerable as they fall in the gap between adult and child services. Where they exist, policies are variable and we call for college level guidelines to be developed and disseminated.