Alcohol-related Attendances Research Articles

Last drinks: A study of rural emergency department data collection to identify and target community alcohol-related violence.

The present study summarises the methodology and findings of a pilot project designed to measure the sources and locations of alcohol-related harm by implementing anonymised 'last drinks' questions in the ED of a rural community. 'Last drinks' questions were added to computerised triage systems at South West Healthcare ED in rural Warrnambool, Victoria, from 1 November 2013 to 3 July 2014. For all injury presentations aged 15 years or older, attendees were asked whether alcohol was consumed in the 12 h prior to injury, how many standard drinks were consumed, where they purchased most of the alcohol and where they consumed the last alcoholic drink. From 3692 injury attendances, 10.8% (n = 399) reported consuming alcohol in the 12 h prior to injury. 'Last drinks' data collection was 100% complete for participants who reported alcohol use prior to injury. Approximately two-thirds (60.2%) of all alcohol-related presentations had purchased their alcohol at packaged liquor outlets. During high-alcohol hours, alcohol-related injuries accounted for 36.1% (n = 101) of all ED injury presentations, and in total 41.7% of alcohol-related attendances during these hours reported consuming last drinks at identifiable hotels, bars, nightclubs or restaurants, or identifiable public areas/events. This pilot demonstrates the feasibility and reliability of implementing sustainable 'last drinks' data collection methods in the ED, and the ability to effectively map the source of alcohol-related ED attendances in a rural community.

Review: Talking about alcohol: communities of practice and patient pathways

It is encouraging to read a paper that tackles some of the very real and complex issues at the sharp end of delivering health care – working with clients with multi-morbidities, in challenging contexts and receiving care and support from multiple agencies. Integrated care is high on the list of policy priorities (National Collaboration for Integrated Care and Support, 2013); the authors have helped to shed light on the issues and challenges faced in attempting to deliver on this agenda. The paper adopts the theoretical lens of communities of practice to study an initiative set up to try and reduce alcohol-related hospital attendance. The working group established to address this issue is the focus of the inquiry. Reading between the lines, the authors imply that the working group came to function as a community of practice, fulfilling the criteria identified by various authors (e.g. Lathlean and le May, 2002; Wenger, 1998) such as a common purpose, a sense of belonging and shared practice. How a group that was ostensibly set up as a project group made the transition to a functioning community of practice is less clear and is an area that would be interesting to explore in some more detail (Kislov et al., 2011). A real challenge to working effectively in an inter-professional, inter-agency setting is managing the boundaries that exist and which act as barriers to knowledge sharing and joint action. The literature on communities of practice (Wenger, 1998) discusses various boundary-spanning activities that can help in this process, including, for example, the use of knowledge brokers, boundary objects and boundary interactions. Again, specific examples of how the group being studied addressed boundary issues during the course of their work would have provided some useful insights. Towards the end of the paper, the authors indicate that organisational changes to primary health care in the National Health Service had an impact on the community of practice, which raises an important question about the relationship between communities of practice and the organisational and health system context in which they are embedded. Increasingly, collaborative approaches are being proposed to tackle a range of issues facing health care systems in the present day. These include large-scale collaborations to accelerate and ease the translation of best evidence into service delivery and clinical practice,

PTH-045 Integrated Alcohol And Hepatology Mdt: Reducing Alcohol-related Hospital Admission And Attendance

IntroductionIn 2010 a joint position paper on behalf of British Society of Gastroenterology, the Alcohol Health Alliance UK, and the British Association for Study of the Liver highlighted that the...

ALCOHOL ATTENDANCE WITHIN THE EMERGENCY DEPARTMENT

Objectives & BackgroundHow much does alcohol contribute to the demands on the Emergency Department (ED)? York is a popular tourist destination, particularly amongst hen and stag parties. But a quarter...

Assessing alcohol-related attendance at emergency departments

Widespread alcohol misuse has implications for the physical, mental and social health of the population, and alcohol-related morbidity and mortality are problems throughout the U.K. One way healthcare practitioners are attempting to reduce alcohol-related harm is to identify patients who misuse alcohol when they attend, or are admitted to, acute care settings. This article gives an overview of the various screening tools that can be used to identify such patients.

When the Cats are away: The impact of sporting events on assault‐ and alcohol‐related emergency department attendances

Despite the attention given to the broad topic of alcohol and violence, there are few studies of this relationship in the context of sporting events and their impact on alcohol-related hospital emergency department (ED) attendances, none of which are Australian. De-identified patient records from Barwon Health's Geelong Hospital ED were analysed from 1 July 2005 to 16 February 2010. Information contained in these records included age, gender, suburb of residence, attendance date and time, arrival mode and reason for attendance. The ED triage database was searched for attendances relating to alcohol, drugs and assault of which 16,940 cases were returned. There was a substantial increase in annual alcohol-related ED attendances from 2006 to 2009. Hierarchical binary logistic regression analyses showed that having a game on a particular day did not contribute to the model, but there were significantly more ED attendances for assaults on days when the Geelong Cats won. There were no significant predictors of ED attendance for alcohol-related harm in the variables studied. The findings of the study suggest that there are significantly more assault-related attendances at the ED in Geelong when the local national football team, the Geelong Cats, won. None of the variables under investigation appears to have impacted on alcohol-related attendances which were not assaults (i.e. injuries or intoxication). It appears that increases in ED attendances associated with the success of a local sporting team are not significantly associated with alcohol use and are more influenced by other factors.

A Retrospective Analysis of the Nature, Extent and Cost of Alcohol-Related Emergency Calls to the Ambulance Service in an English Region

To measure the prevalence, pattern and associated financial cost of alcohol-related ambulance call outs in the North East of England using routinely collected data from the North East Ambulance Service (NEAS). A retrospective cohort study over a 1-year time period (1 April 2009 to 31 March 2010) using NEAS patient record forms. In the North East, 10% of ambulance call outs were alcohol-related. Males were 2.5 times more likely than females to be attended by an ambulance on the street rather than at home. People aged 10-19 had the highest relative risk ratio (3.4) of an ambulance pick up being on the street compare with those aged over 60. These call outs and subsequent accident and emergency (A&E) attendances cost over £9 million in a 1-year period. When extrapolated to the whole country the cost could be as much as £152 million per year. In a 1-year period, we estimated that over 31,000 ambulance call outs were alcohol-related. A large discrepancy was found between manual and electronic recording of alcohol-related ambulance attendances to A&E. The workload and cost of alcohol-related call outs is high and mostly preventable. Ambulance visits may present a teachable moment for brief intervention to reduce alcohol-related risk and harm.

Data sharing for prevention: a case study in the development of a comprehensive emergency department injury surveillance system and its use in preventing violence and alcohol-related harms

ObjectiveTo examine emergency department (ED) data sharing via a local injury surveillance system and assess its contribution to the prevention of violence and alcohol-related harms.Methods6-year (2004–2010) exploratory study analysing injury...

How has the Licensing Act (2003) changed the epidemiology of assaults presenting to a Cambridgeshire emergency department? Before and after study

The Licensing Act (2003) was implemented in England and Wales at midnight on 23 November 2005. Two studies have tried to assess the impact of the new legislation on emergency department attendances in London and South Yorkshire. Both studies reported a small increase in alcohol-related attendances to the emergency department after the new legislation. This study aimed to assess whether the Licensing Act (2003) has had a significant impact on the number and demography of assaults presenting to a Cambridgeshire emergency department. An observational study was conducted using data obtained from the emergency department of the Addenbrooke's Hospital, Cambridgeshire, UK. The study population included all patients, reported of being assaulted, presenting to the emergency department between 23 November 2001 and 23 November 2009. The primary outcome was a change in the number of assaults presenting before and after the implementation of the Licensing Act (2003). Secondary outcomes included changes in the demographics of assault victims including age, sex, time of presentation and ambulance usage. In total, 9214 patients presented to the emergency department of the Addenbrooke's hospital, reported of being assaulted, between 23 November 2001 and 23 November 2009. Sixteen of these patients were excluded because of incomplete data collection. Therefore, 9198 patients were included in the subsequent analysis. The study showed an increase in the number of assaults presenting after the implementation of the Licensing Act (2003). The mean annual number of assaults increased from 1083 to 1216. There was a statistically significant trend towards increasing assaults, z=1.95, P=0.05. There was a significant decrease in the number of female assault victims presenting after the new legislation, P value of less than 0.001. There was a slight change in the age profile of female victims, with a greater proportion of victims aged between 18 and 35 years presenting after the Act, P=0.035. The time of peak presentation for assault cases was significantly later in the evening after the implementation of the Act, with the peak time of presentation moving from a sharp peak at 01:00-01.59 to a broad peak between 01:00 and 03:59, (P=0.004). There was a statistically significant increase in the number of assaults presenting at the weekend, P value of less than 0.001. There was no significant change in ambulance usage after the implementation of the Licensing Act. The Licensing Act (2003) has been associated with minor changes in the epidemiology of assaults presenting to our emergency department. The magnitude of these changes is small, implying that they are practically unimportant. The Licensing Act has failed to reduce the burden of alcohol-related assaults presenting to our emergency department.

The long‐term effect of lockouts on alcohol‐related emergency department attendances within Ballarat, Australia

Alcohol has consistently been demonstrated to increase levels of aggression and violence, particularly in late night licensed venues. Since August 2003, Ballarat (a regional city of approximately 95,000 inhabitants, in Victoria, Australia) has implemented a 3:00 AM 'lockout' with the goal of reducing alcohol-related harms. This paper is the first long-term analysis of the effect of this type of intervention on emergency department (ED) attendances. The aim of this paper is to examine the effectiveness of a lockout intervention within the city of Ballarat, Victoria on alcohol-related ED presentations. This paper examines alcohol-related injury frequencies pre- to post-lockout intervention in Ballarat, Victoria, from 1999 to 2009, as indicated by ED International Classification of Diseases codes for acute alcohol intoxication and assault. These data are further compared with similar data from Geelong, Victoria, as a control. A small reduction in alcohol-related assaults and intoxication rates within Ballarat occurred before and after the introduction of the lockout. However, after this decline these rates steadily increased, surpassing Geelong by 2005. There is no discernible long-term impact on alcohol-related ED attendances of the lockout intervention in Ballarat. As such, other interventions may be more appropriate to reduce alcohol-related ED attendances.

Do community interventions targeting licensed venues reduce alcohol‐related emergency department presentations?

Excessive alcohol consumption is related to substantial health and social order costs. Many of the harms have been identified as coming from licensed venues. Most communities struggle to find interventions that are effective, particularly in an environment of little federal government action. Furthermore, most interventions are based on little or no empirical evidence. This study aims to investigate the effect of a suite of interventions on emergency department (ED) attendances in Geelong, Australia. This paper reports stage one findings from the Dealing with Alcohol-Related Problems in the Night-time Economy project (DANTE) and specifically examines all alcohol-related injury frequencies before to after intervention in the City of Greater Geelong of Victoria, Australia, from 2005 to 2009. Auto-regressive integrated moving average time-series were used to determine the effect of the interventions on ED attendances in Geelong. There were 3934 triage presentations involving alcohol. Over two-thirds (68.9%) of triage presentations were male and over half (58.5%) of alcohol-related attendances occurred on the weekend. The time-series analyses indicated that ID scanners (z = 2.66, P < 0.001) and the Just Think awareness campaign (z = 4.21, P < 0.001) were significant predictors of increases in alcohol-related injury presentation rates to the ED. Overall, the community interventions implemented have not been associated with reduced alcohol-related attendances at the ED. The findings raise questions about whether targeting the night-time economy is effective and whether interventions should instead be targeted at reducing whole-of-community alcohol consumption.

Diverging trends in alcohol consumption and alcohol‐related harm in Victoria

To examine recent trends in alcohol-related harm and risky drinking in Victoria, Australia. The study compiled eight measures of alcohol-related harm from published and unpublished sources, covering data relating to health, crime, alcohol treatment and traffic crashes for the financial years 1999/2000 to 2007/08. In addition, published estimates of short and long-term risky drinking from three-sets of surveys between 2001 and 2007 were examined. Six of the eight harm indicators substantially increased, while only alcohol-related mortality and single-vehicle night-time crashes remained relatively stable. In particular, rates of emergency presentations for intoxication and alcohol-related ambulance attendances increased dramatically. Contrastingly, survey-derived estimates of the rate of risky-drinking among Victorians were stable over the time-period examined. Evidence across the data examined suggests significant increases in alcohol-related harm taking place during a period of relatively stable alcohol consumption levels. This disparity may be accounted for by changing drinking patterns among small, high-risk, subgroups of the population. The sharply increasing rates of alcohol-related harm among Victorians suggest that changes to alcohol policies focusing on improving public health are necessary.

Effect of 24-h alcohol licensing on emergency departments: the South Yorkshire experience

BackgroundThe alcohol Licensing Act (2003) was introduced to England and Wales on 23 November 2005. A single-centre study in 2007 from St Thomas's Hospital concluded that their alcohol-related attendances had...

An evaluation of alcohol attendances to an inner city emergency department before and after the introduction of the UK Licensing Act 2003

BackgroundThe Licensing Act 2003 (The Act) was implemented on the 24th November 2005 across England and Wales. The Act allowed more flexible and longer opening hours for licensed premises. We investigated the effect of The Act on alcohol related attendances to an inner city emergency department in Birmingham, UK.MethodsWe compared the proportion and time of alcohol related emergency department attendances in one week periods in January 2005 and 2006, before and after the implementation of The Licensing Act 2003. An alcohol related attendance was defined as any attendance where there was any documentation of the patient having consumed alcohol before presenting to the emergency department, if they appeared intoxicated on examination, or if alcohol attributed to their final diagnosis.ResultsThe total weekly attendances increased slightly from 1,912 in 2005 to 2,146 in 2006.There was non-significant reduction in the proportion of alcohol related attendances between 2005 (3.6%) and 2006 (2.9%). A significantly greater proportion of attendances occurred at the weekend between 18.00 and 23.59 in 2005 (61.4%) than in 2006 (17.2%). There was a corresponding significant increase in the weekend proportion of attendances occurring between 03.00 to 05.59 in 2006.ConclusionOur findings show that there was a change in the pattern of alcohol related attendances to the emergency department around the time of implementation of the Licensing Act 2003, which has implications for delivery of emergency department services.

The Impact of a Change in the Alcohol Licensing Legislation in the United Kingdom on Attendances in the Emergency Department: A Cohort Study

Objectives: to assess the impact of the new UK alcohol licensing law introduced in November 2005, allowing premises serving alcohol to remain open 24h a day, on overnight attendances to the emergency department (ED). Methods: retrospective cohort study at ED of St Thomas’ Hospital, London over 2 months, one before and after the introduction of the new law. All those aged over 16 years who attended the ED between 2100h and 0900h during the two study periods (March 2005 and 2006) were included. We defined an alcohol-related attendance as having occurred if there was documentation of alcohol consumption prior to attendance, or of alcohol intoxication in relation to the patient examination or final diagnosis.

Alcohol: a missed opportunity. A survey of all accident and emergency departments in England

Aim: To determine the extent to which the recommendations of the alcohol harm reduction strategy for England and the Choosing Health white paper for the provision of screening and brief...

Impact of the new UK licensing law on emergency hospital attendances: a cohort study

Objectives: To assess the effect of the new UK alcohol licensing law on overnight attendances to the emergency department. Methods: A retrospective cohort study at the emergency department of St...

A 6-months assessment of the alcohol-related clinical burden at emergency rooms (ERs) in 11 acute care hospitals of an urban area in Germany

BackgroundThe purpose of the study was to identify and to profile alcohol-related attendances to emergency rooms (ERs) of 11 hospitals of various medical specialties covering a large urban population, to assess risk factors associated with short-stay cases, repeat attendances and higher degree of alcohol consumption and to estimate their impact on the alcohol-related burden at ERs.MethodsA 6-months study was carried out to obtain clinical and administrative data on single and multiple attendances at ERs in 11 governmental acute hospitals in a large city in Germany. All alcohol-related attendances at ERs of study hospitals were eligible. A broad definition of alcohol-related attendances independently from alcohol diagnosis and various demographic, clinical and administrative measures were used. Odds ratios for the associations of these measures with duration of stay, repeat attendances and higher degrees of alcohol consumption were derived from multivariate binomial and multinomial logistic regression models.Results1,748 patients with symptoms of alcohol consumption or withdrawal (inclusion rate 83.8%) yielded 2,372 attendances (3% of all medical admissions), and resulted in 12,629 inpatient-days. These patients accounted for 10.7 cases per 1,000 inhabitants. The average duration of inpatient stay was 10 days. 1,451 of all patients (83%) presented once, whereas the median of repeat attendances was three for the remaining 297 patients. Short-stay cases (<24 hours) were significantly linked with male gender, alcohol misuse, trauma (or suspicion of a trauma) and medical specialties. Increased levels of alcohol consumption at first attendance were significantly associated with repeat attendances in due course. In a multinomial logistic regression model higher degrees of alcohol consumption were significantly associated with male gender, trauma, short-stays, attendance outside regular working time, and with repeat attendances and self-discharge.ConclusionApart from demographic factors, the alcohol-related clinical burden is largely determined by short-stay cases, repeat attendances and cases with higher levels of alcohol consumption at first attendance varying across medical specialties. These findings could be relevant for the planning of anti-alcoholic interventions at ERs.

The half-life of the ‘teachable moment’ for alcohol misusing patients in the emergency department

Background: To determine whether the length of time between alcohol-related attendance in the emergency department (ED) and follow-up appointment with an alcohol health worker (AHW) alters attendance rate at the AHW clinic. Methods: We examined paper and computerized records made by AHWs over a 4-year period, collecting data on the length of time between identification of alcohol misuse and the appointment with the AHW, and whether the appointment was kept. Results: There is an inverse relationship between the length of time between identification of alcohol misuse and AHW appointment and the subsequent likelihood of keeping that appointment. Conclusions: To maximise attendance rates at AHW clinics, the delay between the identification and intervention for alcohol misusing patients must be kept to a minimum, preferably giving an appointment on the same day as the attendance in the ED.

Alcohol and the accident and emergency department: a current review.

Alcohol misuse constitutes a major problem in our modern society and both physical and mental alcohol-related harm result in a large number of Accident and Emergency (A&E) attendances, thus imposing a significant burden on the workload and financial resources of the department. The current management of problem drinking by most A&E departments could be further improved. The introduction of a holistic approach that includes efficient screening instruments and effective brief, anti-alcoholic interventions, for the management of these patients must be considered. This should strengthen the preventive role of A&E departments, and, in the long term, may result in a decrease in the number of cases of alcohol misuse and in alcohol-related attendances.