New research alcohol-related admissions to A&E

Two studies were released in the last couple of weeks that tell different stories about the impact of the government's alcohol policies on alcohol-related admissions to Accident and Emergency Departments.

Newton et al's Impact of the new UK licensing law on emergency hospital attendances: a cohort study was a retrospective cohort study at the emergency department of St Thomas’ Hospital, London over 2 months, one before and one after the introduction of the new legislation.

All people over the age of 16 years who attended the emergency department between 21:00 and 09:00 during the two study periods (March 2005 and March 2006) were included. An alcohol-related attendance was defined as having occurred if there was documentation of alcohol consumption before attendance, or of alcohol intoxication in relation to the patient’s physical examination or final diagnosis.

The authors conclude that:

Overnight alcohol related emergency attendances to St Thomas’ hospital increased after the introduction of new alcohol licensing legislation. If reproduced over longer time periods and across the UK as a whole, the additional burden on emergency care could be substantial.  Abstract.

In the same edition (August 1 2007, Volume 24, Issue 8) of Emergency Medicine Journal, is Patton et al's Alcohol: a missed opportunity. A survey of all accident and emergency departments in England.  The aim of this study was 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 interventions for hazardous and harmful drinkers have been adopted by accident and emergency departments.

The researchers found that:

• 4 departments (of a total of 191) use formal screening tools and 24 ask general questions about consumption (98.9% response rate).
• Blood alcohol levels were measured as required by 100 departments.
• No departments routinely measure blood alcohol, and 84 departments never assess blood alcohol levels.
• Alcohol-related attendances were formally recorded by 131 departments.
• Access to an alcohol health worker or a clinical nurse specialist was reported by 32 departments.

The conclusion:

Although departments may be willing to address hazardous alcohol consumption, the low numbers of departments utilising formal screening tools suggests that patients who may benefit from help or advice remain undetected.  Abstract

See also "Hospitals do not probe drinking" BBC News story

Comments

[Adrian Brown]

It was interesting to see these two articles getting such media coverage.

Not least because the same issue of the EMJ published our initial paper about blood alcohol concentrations collected in St Mary's A&E resusc room.

While not intending to reiterate what we said there, we looked at the articles as telling a story:

Newton et al "There are more people coming to our A&E with alcohol intoxication related issues since the Licensing Laws changed"

Patton et al "A&E departments are not asking patients about alcohol"

Csipke et al "Not only are we asking patients about alcohol, but we are seeking ways to help more patients"

Ourselves and St Thomas's may have different experiences, but we are both doing something.

In both cases, something as simple as highlighting the effect of drinking to patients can have a positive effect on their health. And on the AED.

Adrian Brown
St Mary's Hospital,
Paddington