Introduction Portsmouth Hospitals NHS Trust has the highest rate of alcohol related hospital admissions in the South East of England (1993 per 100 000 population for 2009/2010). Admissions with complications of cirrhosis have doubled in under 4 years and recorded deaths from liver cirrhosis exceed the regional and national averages. As part of a comprehensive strategy to tackle the rising burden of alcoholic cirrhosis, a dedicated team of alcohol nurse specialists has been deployed to identify all alcohol related admissions at the earliest time point and initiate management. We conducted a prospective evaluation of the patients referred to the service over a 4-month period.
Aim To determine the demographic pattern of patients admitted with alcohol related illnesses in a single large hospital serving a population of 650 000.
Method All patients at the Queen Alexandra Hospital with an alcohol related admission identified during the study period were referred to the specialist nursing service and recorded on a secure database. A comprehensive clinical assessment was made by a team of 3 specialist nurses working to agreed protocols. The WHO Alcohol Use Disorders Identification Test (AUDIT) score was recorded along with data regarding age of first alcohol exposure, regular usage and problem drinking. Liver related morbidity was determined by clinical assessment, standard blood parameters and by calculation of Model for Endstage Liver Disease (MELD) and Glasgow Alcoholic Hepatitis (GAHS) scores.
Results During the study period, 495 new patients were referred to the service. 71% were identified and referred in the ED or MAU, the remainder from inpatient wards. Mean age was 50 years (range 18–91) and 72% were male. 97.5% of patients were of white British ethnicity and only 11% were in regular employment. There were no gender differences in the proportion of younger drinkers <40 years (20% in both sexes). Overall, 12% of patients referred with alcohol misuse disorders were aged over 70 years. Our cohort demonstrated heavy current alcohol misuse with a mean weekly consumption of 229 units at admission (range 8–860) and 50% of patients recorded the maximum AUDIT score of 40. The mean age of first drinking alcohol was 11 years (range 3–26) and the mean age of establishing regular use was 22 (range 11–65). Laboratory parameters identified a high proportion of patients with subclinical evidence of liver injury. Supervised detoxification was completed in 170 patients.
Conclusion Alcohol related hospital admissions can be rapidly identified and managed by a dedicated specialist nursing team working in conjunction with hepatologists and acute physicians. Our cohort demonstrated strong links between poor socioeconomic status and early age of exposure to alcohol, age of regular alcohol misuse and long-term excessive drinking. We have now instituted formal screening of all hospital admissions in ED and MAU with direct electronic referral to the liaison service where alcohol misuse is a factor.