Alcohol challenges in hospital
Alcohol related harms are highly prevalent globally, with high associated rates of mortality. Harmful alcohol use is a causative factor for many health conditions, including liver disease, multiple cancers and trauma related injuries. Furthermore, alcohol has a huge impact on mental health (NHS Long Term Plan; Chapter 2: More NHS action on prevention and health inequalities – Alcohol), wellbeing and quality of life.
Dependant drinkers are at the highest risk of alcohol related physical and mental health conditions (NHS Long Term Plan; Chapter 2: More NHS action on prevention and health inequalities – Alcohol).
Not only does alcohol cause significant harm to the individual, but when compared with other drugs of abuse, alcohol also leads to the most harm at a societal level.
Over 1.1 million hospital admissions per year are related to alcohol, and 12-15% of emergency department admissions are alcohol related (NHS Long Term Plan; Chapter 2: More NHS action on prevention and health inequalities – Alcohol).
There were 9,641 alcohol specific deaths in the UK in 2021, the highest number ever recorded (Alcohol-specific deaths in the UK – Office for National Statistics (ons.gov.uk)).
What is an Alcohol Care Team?
To combat the challenges associated with addressing alcohol use disorders in hospital, the NHS Long Term Plan provided funding to support 47 new and existing Alcohol Care Teams (ACT) in England.
ACTs are dedicated teams of specialist nurses and practitioners, based within inpatient settings whose primary aim is supporting patients who are drinking to harmful levels. A hospital admission often provides the first opportunity for alcohol dependence or alcohol related harms to be identified and diagnosed.
Early and specialist interventions by individuals with expertise in the assessment and management of alcohol use disorders provide the best care to patients, whilst also preventing unnecessary hospital admissions and lengthy hospital stays (NHS Long Term Plan; Chapter 2: More NHS action on prevention and health inequalities – Alcohol). As such, ACTs provide a unique opportunity to deliver specialist expertise and interventions for alcohol dependent patients, or those attending hospital with alcohol intoxication or other alcohol related complications, in a timely and reactive manner. NHS England recommend that ACTs should (Public Health England: Alcohol Care Teams Core Service Descriptor):
- Be led by a senior clinician.
- Facilitate widespread case identification and brief advice.
- Provide comprehensive alcohol assessment.
- Contribute to nursing and medical care provision.
- Provide psychosocial interventions.
- Manage medically assisted alcohol withdrawal.
- Plan safe discharge, including referral into community alcohol services.
The Sandwell and West Birmingham Hospitals Alcohol Care Team
The Sandwell and West Birmingham Hospitals (SWB) ACT was first established in 2018 and has been led by a consultant clinical toxicologist.
The SWB ACT’s core aims are to:
- Expertly assess, identify, and manage alcohol withdrawal.
- Prevent unnecessary hospital admission for those who can be effectively managed on an out-patient basis.
- Provide ongoing outpatient support.
- Provide bespoke training and education in relation to alcohol use disorders to SWB staff.
Since 2018, the SWB ACT has grown from 7 staff into a team of 13, who have a diverse skill set. The team consists of an alcohol nurse consultant, lead alcohol nurse, alcohol specialist nurses, a dedicated Fibroscan alcohol nurse, alcohol practitioners and full time administrative support. The ACT currently provides a 7-day service, delivering across all domains of the core service descriptors for an ACT as recommended by Public Health England (Public Health England: Alcohol Care Teams Core Service Descriptor).
What have we achieved?
Providing person centred, holistic care for our patients is at the forefront of the SWB ACT philosophy. Trust alcohol withdrawal guidelines were updated to include referrals to the ACT from both emergency and inpatient departments. We have a strong, evidenced framework that emergency admission for alcohol detoxification rarely achieves long term abstinence as addiction is largely a psychological condition so physical interventions alone are rarely sufficient (Hospital Management of Alcohol Withdrawal: Elective versus Unplanned Admission and Detoxification).
Instead, we initiated an innovative approach which aims to prevent unnecessary admissions by offering outpatient support alongside psycho-social interventions, advice on safe reduction and subsequent admission for elective detoxification. Outpatient follow-up is also provided post-elective admission. This alternative to emergency detoxification led to the SWB ACT being awarded a Nursing Times award in 2022. This approach has also benefitted the trust, with an estimated 2,067 unnecessary bed days spared, equating to a saving to the trust of approximately £963,500 in the team’s first five years.
The ACT has also consistently exceeded its key performance indicator targets over the past 5 years (including reviewing 99.8% and 99.7% of Accident and emergency referrals within an hour and ward-based referrals within 24 hours, respectively), has offered in excess of 3,900 outpatient appointments and has delivered over 2,300 educational sessions to SWB staff.
Furthermore, a recent patient feedback survey indicated that 95% of our patients stated that they are satisfied with the care they received from the ACT, and felt that the ACT made a positive change to their ongoing alcohol use.
The future of the SWB ACT
We have recently recruited a full time Fibroscan Alcohol Nurse, providing bedside Fibroscans to our patients in the emergency department, inpatient wards and at outpatient clinics; facilitating trust adherence to NICE guidelines NG50 (Overview | Cirrhosis in over 16s: assessment and management | Guidance | NICE). We are already seeing the benefit of this service by providing patients with health promotion and early identification of liver cirrhosis.
Furthermore, we have partnered with the Addictions Research Group at the University of South Wales in order to raise awareness among our patient population and staff about Alcohol Related Brain Damage.
Written by Carol Appleyard, Lead Alcohol Nurse, Alcohol Care Team at Sandwell and West Birmingham Hospitals NHS Trust.
All IAS Blogposts are published with the permission of the author. The views expressed are solely the author’s own and do not necessarily represent the views of the Institute of Alcohol Studies.