How to reduce acute hospital admissions of Alcohol overdose patients using Alcohol Care Team initiative?
It is estimated that the annual cost of alcohol- related harm to the NHS in England is £2.7 billion (Department of Health 2008). Of this amount, 78% of the costs were incurred as hospital- based care. Inpatient costs alone were responsible for 45% of this spend (NHS Confederation and Royal College of Physicians 2010). A significant proportion of this spending is avoidable and alcohol services could be more effective, cheaper and person-centred if each area had a plan to deliver evidence-based care in an appropriate setting, integrated between primary and secondary care.
Very few hospitals have dedicated alcohol services, and a 2009 survey showed that only 42% of acute hospitals had any alcohol specialist nurse support (Ward et al 2009).
The principal component of this initiative is for a multidisciplinary Alcohol Care Team in each district hospital, led by a consultant with designated sessions, who will collaborate across hospitals and primary care, to develop a coordinated alcohol treatment and prevention programme. This team would organise systematic interventions and alcohol specialist nurses. The evidence in this document is not only for the team, but for a variety of actions, including brief interventions, specialist alcohol nurses and ways of reaching out to patients.
Alcohol Care Teams coordinate policies of care across acute departments, including Accident and Emergency (A&E). They provide access to brief interventions and appropriate services within 24 hours of the detection of alcohol-related problems. Structured advice lasts for 20–40 minutes and involves personalised feedback to individuals about their level of health risk because of alcohol consumption, practical advice about reducing alcohol consumption, with a range of options for change, and written information to support the advice.
Hospitals have coordinated policies of care for patients with alcohol-related problems in A&E and Acute Medicine departments, including a 7-day Alcohol Specialist Nurse Service, a Mental Health Crisis Team and Alcohol Link Workers’ Network.
Each health area can establish a hospital-led, multi-agency Assertive Outreach Alcohol Service (AOAS) to move the most frequent attendees and biggest consumers of hospital resources into a more appropriate, supported, community environment. These initiatives may require a degree of ‘pump-priming’ to get them up and running.