1 / 59

Hospital Alcohol Project James Crosbie, Gastroenterologist Alcohol Delivery Group 1 st July 2011

Hospital Alcohol Project James Crosbie, Gastroenterologist Alcohol Delivery Group 1 st July 2011. Hospital Alcohol Project James Crosbie, Gastroenterologist Alcohol Delivery Group 1 st July 2011. Hospital Alcohol Project. Background Objectives Personnel Activity & outcomes

gabe
Download Presentation

Hospital Alcohol Project James Crosbie, Gastroenterologist Alcohol Delivery Group 1 st July 2011

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Hospital Alcohol ProjectJames Crosbie, GastroenterologistAlcohol Delivery Group 1st July 2011

  2. Hospital Alcohol ProjectJames Crosbie, GastroenterologistAlcohol Delivery Group 1st July 2011

  3. Hospital Alcohol Project • Background • Objectives • Personnel • Activity & outcomes • 1. Emergency Dept • 2. Gastroenterology • 3. Turning Point • The way forward (& barriers)

  4. RPIWSarah Fox & Ben Seale

  5. Background

  6. National Indicator 39 (NI 39) • Measures rate of alcohol related admissions using Hospital Episodes Statistics (HES) • “Alcohol Attributable Fractions” for medical conditions applied to HES • 47 conditions : • 13 wholly attributable conditions • 22 partially attributable chronic conditions • 2 partially attributable acute consequences. • eg ALD =1, hypertension <1 (depending on age & sex)... • 60-70% NI39 admissions in NE “partially attributable”

  7. National Indicator 39 (NI 39) • Measures rate of alcohol related admissions using Hospital Episodes Statistics (HES) • “Alcohol Attributable Fractions” for medical conditions applied to HES • 47 conditions : • 13 wholly attributable conditions • 22 partially attributable chronic conditions • 2 partially attributable acute consequences. • eg ALD =1, hypertension <1 (depending on age & sex)... • 60-70% NI39 admissions in NE “partially attributable”

  8. Objective • Reduce Alcohol Related Hospital admissions (NI39?) • Increase hospital based resources for patients with alcohol related illness • Alcohol Steering group

  9. CHS Personnel • Emergency Dept • Kate Lambert ED Consultant • Cain Thomason Data manager • Gastroenterology • James Crosbie Clinical Lead • Deb Smith Alcohol Specialist Nurse • Turning Point • Geoff Anderson Senior Alcohol Worker • Laura Thubrun Alcohol Worker • Tracey Stewart Alcohol Worker

  10. 1. Emergency Department

  11. 1. Emergency Department The Scale of the Problem: • April 2009 – March 2011 • 9150 Alcohol related ED attendances • 1337 Alcohol related admissions via ED • 269 of these readmissions by 136 individuals • June 2010 – May 2011 • Top 50 attendees accounted for 598 attendances • Top 10 attendees accounted for 328 attendances

  12. 1. Emergency Department The Scale of the Problem: • April 2009 – March 2011 • 9150 Alcohol related ED attendances • 1337 Alcohol related admissions via ED • 269 of these readmissions by 136 individuals • June 2010 – May 2011 • Top 50 attendees accounted for 598 attendances • Top 10 attendees accounted for 328 attendances

  13. Year 1 of the Hospital Alcohol Project 2009/10 – 2010/11: • Total ED attendances increased by 1% • Alcohol related attendances fell by 8% (10% men 5% women) • Alcohol % total attendances fell by 0.66%

  14. Heavy Service Users Group • Initial activity stopped due to info sharing barriers • Restarting following RPIW • Info sharing protocol v5.1 • Care Navigator post • Top 20 frequent attenders & others from ED dashboard (or if complex needs identified) • Kate Lambert -Probation • Data manager -Mental Health • ASN -Housing • DAT -C4

  15. Heavy Service Users Group • Initial activity stopped due to info sharing barriers • Restarting following RPIW • Info sharing protocol v5.1 • Care Navigator post • Top 20 frequent attenders & others from ED dashboard (or if complex needs identified) • Kate Lambert -Probation • Data manager -Mental Health • ASN -Housing • DAT -C4 • James Crosbie -GP

  16. Youth Drug and Alcohol Project • Service reinstated with permanent Hospital Link Worker March 2011 • 36 alcohol related ED attendances < 18 since then (2.25 /week) • Age range 10 – 17 years (median 15 mean 14) • 19 referred to YDAP • 10 attended Brief Intervention • 3 sent information packs • 2 already known to YDAP, • 2 open referrals to YDAP • 2 declined any input. • Of the 17 not referred, 13 have been sent letters from YDAP offering follow up and information packs.

  17. BREAK

  18. 2. Gastroenterology

  19. 2. Gastroenterology • Alcohol Specialist Nurse (ASN) • Introduction of symptom triggered detox • Alcohol IBA training • Targeted clinical areas & staff • Embedded in junior doctor teaching programme • SASQ embedded in medical admission proforma

  20. Alcohol Specialist Nurse • Inpatient referrals: harmful drinkers • Liaison with : • Gastroenterology • Community team (Counted 4) • Turning Point • DAT • Other agencies • Facilitate discharge of gastro patients through early follow up • Phoneline, voicemail & bleep for direct patient access • Clinic for review of discharged patients, direct access and scheduled follow up • Day case paracentesis service with view to nurse led service • Nurse prescribing • Alcohol Link Nurse Network (all wards)

  21. NeRAF NECA

  22. Alcohol Specialist Nurse Activity Jan 2011 – (mid) June 2011 • 392 referrals (70 / month) • Onward Referrals: • TP: 122 C4: 7 DAT: 17 • Housing: 17 Other:29 Huntercoombe: 8 • 285 clinic follow up • 165 BI • 161 liver disease blood tests + 38 liver USS • 128 telephone referrals (56 onward referral / discussion • Direct access paracentesis 26

  23. Alcohol Specialist Nurse

  24. Profile

  25. Staff Education & Training • Alcohol Link Nurse network • Nursing Clinical skills • Medical students • Hospital meetings

  26. Inpatient detox • Previous model: Fixed dose detox • 5-7 day admission with controlled reduction • Standard dosing to all “increasing risk” drinkers • Symptom triggered detox (NICE recommended) • Identify dependence (withdrawal) • Reduce LOS for those not requiring treatment • Increased monitoring & treatment for withdrawal • Reduction in overall drug dispensing & cost • Increased effectiveness of treatment when needed

  27. CIWA-Ar for the management of Alcohol Withdrawal Syndrome Patient name______________________ X number_________________________ Date started______________________ Time (24hour)_____________________

  28. Pre CIWA (baseline) audit June – August 2010 • 239 admissions for 194 unique patients • 26 (13%) had been admitted >1 occassion (group A) Average amount of chlordiazepoxide used during admission from both single admission (group B) and repeat admission (group A) patients

  29. Pre CIWA (baseline) audit June – August 2010 • 239 admissions for 194 unique patients • 26 (13%) had been admitted >1 occassion number of admissions and average length of stay of both repeat and single admission patients.

  30. Turning Point

  31. Turning Point • All inpatients & A&E attendances identified as problem drinkers • Monday to Saturday service (diary appointment if intoxicated or out of hours) • Delivery of alcohol interventions • Initial assessment with onward referral to community services: • NeRAF • NECCA • Drug & Alcohol Team • Counted 4

More Related