Detection of high-risk alcohol behavior in hospital inpatients using the WHO AUDIT-C screening tool.
C. Murphy, R. Kearns, A. O’Sullivan, Y. Malik, O. Crosbie
Department of Hepatology and Gastroenterology , Cork University Hospital.
In 2013 alcohol-related illness cost the HSE €800 million. The National Alcohol Diary Survey of 2013 showed that 54% of adult drinkers in the population are classified as harmful drinkers, using the WHO AUDIT-C screening tool. The National Confidential Enquiry into Patient Outcome and Death report of 2013 into alcoholic-liver disease related deaths in the UK made the key recommendation that all patients presenting to hospital services should be screened for alcohol misuse with a view to both identifying patients with or at risk of develping alcoholic liver disease. Brief intervention has been shown to be some-what effective in reducing alcohol consumption patterns.
1) To investigate recording of alcohol consumption patterns on admission. 2) To apply the AUDIT- C tool to assess recognition of and appropriate referral and treatment of high-risk alcohol consumers. preprocess
A chart review of 82 medical and surgical admissions on four wards was undertaken over a two-week period. Details of alcohol consumption patterns documented on admission were recorded. The patients were then screened for high-risk alcohol consumption using the validated WHO AUDIT- C screening tool.
82 patients (48% female, 52% male) were studied with a mean age of 70 years. Alcohol consumption patterns were recorded in 30% of patients on admission. Upon patient questioning using AUDIT-C, 51% of patients admitted to drinking alcohol at least once a month. 36% of these were subcategorized into people with high-risk drinking behavior. 60% of these high-risk drinkers had no alcohol history recorded on admission. 13% of this cohort were reviewed by liaison psychiatry. 60% of extremely heavy drinkers (AUDIT-C score 12) at risk of development of acute alcohol withdrawal were not identified or treated appropriately on admission.
An acute hospital admission remains an opportunistic time to firstly identify and then intervene in patients displaying high-risk alcohol behavior who are at risk of developing alcoholic liver disease. Unfortunately recording, identification and treatment of patients with high-risk drinking patterns presenting at CUH is currently inadequate. Use of the validated WHO AUDIT-C screening tool on admission would help stratify patients into groups in need of further assessment by the liaison psychiatry.