Alcohol use in a general hospital inpatient population Hear no evil, see no evil Dr' Kieran OLoughli

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Alcohol use in a general hospital
inpatient population

Hear no evil, see no evil
Dr. Kieran OLoughlin
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Background

• 1133 admissions in an Irish hospital 30 of men
  and 8 of women met the DSM IV criteria for
  alcohol abuse or dependence1.
• For patients attending accident and emergency the
  figure may be as high as 402.

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Background

• Screening and brief interventions have been shown
  to have beneficial effects with respect to
  long-term outcome in cases of alcohol misuse3.
• Hospital-based psychiatric substance use
  consultations improve engagement in alcohol
  rehabilitation and treatment outcome4.

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• In 2006 the Psychiatry of Later Life liaison
  service in Tallaght Hospital Dublin, received
  only 8 consultation requests for alcohol misuse
  (out of a total of 211 requests for psychiatric
  consultation) representing less than 4 of
  all referrals.

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Objectives

• 1.
• We aimed to determine if poor documentation of
  alcohol intake is a problem amongst the NCHD
  (Non-Consultant Hospital Doctor) population in
  Tallaght hospital.

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Objectives

• 2.
• We aimed to assess NCHDs attitudes towards
  alcohol misuse to determine if there are
  specific patient variables which may influence
  the decision to refer to specialist services.

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Objectives

• 3.
• We aimed to assess NCHDs knowledge of the safe
  levels of alcohol consumption for both males and
  females.

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Methodology

• Part 1 Chart Review
• Part 2 Questionnaire

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Methodology

• Part 2 CASE VIGNETTES
• 1. Give no further advice regarding alcohol
  intake
• 2. Advice to cut back on alcohol intake
• 3. Advice to abstain from further drinking
• 4. Recommend self-referral to alcohol services
• 5. Refer to General Practitioner for management
• 6. Refer to specialist services

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Results

• The differences demonstrated between all three
  subgroups in Table 1 (medical vs. surgical, male
  vs. female, gt65 vs. lt65) are statistically
  significant (0.02lt p lt 0.05 in all cases).
• However the relatively large number patients in
  the alcohol history but no quantity subgroup
  contributes strongly to the calculation of
  statistical significance.

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Implications Part 1

• 62 of patients Quantity of alcohol consumed
  not documented.
• It may represent an attitude amongst NCHDs
  towards alcohol intake in certain patient
  populations as defined by age, gender or the
  nature of presenting complaint.
• It may represent a lack of awareness on the part
  of NCHDs as to the importance of taking an
  alcohol history.
• It may simply represent a lack of knowledge on
  the part of NCHDs as to how to take an alcohol
  history.

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Results Part 2

• Our questionnaire dealt with treatment issues.
• 2 case vignettes
• the presenting complaint was consequent upon
  alcohol misuse
• Case vignette No. 1 30
• Case vignette No. 5 78
• (chose option of referral to specialist services)

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Results Part 2

• 4 Case vignettes P/C not consequent upon
  alcohol misuse.
• Case vignette No. 2 12.
• Case vignette No. 3 8
• Case vignette No. 5 4
• Case vignette No. 6 9

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• We must concede that the failure of NCHDs to opt
  for referral to specialist services may also
  indicate a lack of knowledge as to what services
  are available to them. To what extent this factor
  influenced the findings of our study is unclear.

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Results

• 95 of NCHDs correctly identified the recommended
  weekly limit of alcohol consumption for both
  women and men (14 units and 21 units
  respectively).

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Conclusion

• Medical education has been shown to lead to
  improvements in the detection of alcohol misuse
  by hospital interns5.
• This survey clearly identifies a need for
  further education of NCHDs with regard to the
  detection of excessive alcohol intake in their
  patients.

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Conclusion

• Implement educational programme.
• Complete audit cycle next year.

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References

• 1. Hearne R, Connolly A, Sheehan J. Alcohol
  abuse prevalence and detection in a general
  hospital. J R Soc Med 20029584-87.
• 2. Conigrave K, Burns FH, Reznik RB, Saunders JB.
  Problem drinking in emergency department
  patients the scope for early intervention. Med J
  Aust 1991154801-5.
• 3. . Babor TF, Higgins-Biddle JC, Dauser D,
  Burleson JA, Zarkin GA, Bray J. Brief
  interventions for at-risk drinking patient
  outcomes and cost-effectiveness in managed care
  organizations. Alcohol Alcohol. 2006
  Nov-Dec41(6)624-31.
• 4. Hillman A, McCann B, Walker NP. Specialist
  alcohol liaison services in general hospitals
  improve engagement in alcohol rehabilitation and
  treatment outcome. Health Bull (Edinb). 2001
  Nov59(6)420-3.
• 5. Gaughwin M, Dodding J, White JM, Ryan P.
  Changes in alcohol history taking and management
  of alcohol dependence by interns at the Royal
  Adelaide Hospital. Med Educ 2000 34(3)170-4.