Does the Alcohol Liaison Nurse Service in the Belfast Trust impact on ED attendance and hospital admissions?
E.Clarke, K.Adams and R.McCorry
Liver Unit, Royal Victoria Hospital, Belfast, Northern Ireland
Alcohol related harm is estimated to cost Health and Social Care in Northern Ireland (HSC) £250 million annually. It is an escalating issue for our hospitals with a 61% increase in admissions resulting from alcohol related illness between 2000/01 and 2009/10. In response to this crisis alcohol liaison nurse (ALN) services have been established to co-ordinate detection and management of alcohol use disorders.
We investigated if consultation with an alcohol liaison nurse (ALN) reduced emergency department (ED) attendances and hospital admission in the 6 months following initial referral.
We compared both ED attendance and hospital admissions 6 months pre- and post- consultation with an ALN. All inpatients under the age of 55 years referred from February to September 2014 across the 3 Belfast Trust hospitals were included. An existing ALN referral database was used to identify patients.
A total of 176 patients were referred (male 69.9%; median age 44 years). Of these, 78.4% (n=138) had presentations directly related to alcohol. In the 6 months pre- ALN intervention there were 176 hospital admissions and 184 ED attendances (total = 360). In the 6 months post- ALN intervention there were 301 hospital admissions and 241 ED attendances (total = 542). This equates to a 50.6% increase in all hospital attendances in the 6 months after consultation. Only 30 (17.0%) patients were re-referred to the ALN service within the 6 months. 41 (23.3%) patients had no hospital attendances either pre- or post consultation. Eight patients (3.9%) had more than 10 ED attendances/hospital admissions either pre- or post-consultation (range 16-65). They accounted for 31.2% of all hospital attendances (total = 281; 114 pre-, 167 post-).
Alcohol use disorders contribute to high volumes of attendances and admissions in the Belfast Trust. The majority of admissions were directly related to alcohol and its complications. These individuals may be less receptive to change hence the increase in hospital attendances following intervention. The volume of referrals is low when the presentation is non-alcohol related. A recent trust-wide audit suggested that we may only be detecting 2.6% of all potentially dependent drinkers attending ED. A planned expansion in the number of ALN posts and implementation of a 7day service should impact positively on patient identification. A small number of complex patients account for a significant proportion of hospital admissions and there may be scope to manage these individuals with an alcohol assertive outreach team.