Introduction NICE have provided a framework to assess and manage alcohol related admissions and alcoholic hepatitis. The study aimed to assess the knowledge of, and compliance with these guidelines in a busy district general hospital.
Methods All physicians (f1 to consultant) involved in the medical take were sent an email survey via the website http://www.surveymonkey.com in January 2011. Six questions were posed to assess appreciation of the new guidelines with regards to the assessment of the alcohol withdrawal syndrome, correct prescription of parenteral thiamine and risk stratification, recognition and the specific management of alcoholic hepatitis. Free text and multiple choice questions were used. 39 doctors completed the survey; 15 were consultants and 24 junior doctors.
Results 100% of respondants correctly identified three symptoms or signs of the alcohol withdrawal syndrome. However only 13% recognised that the correct length of prescription of parenteral thiamine was at least 5 days in suspected Wernike's encephalopathy. Only 40% identified the Maddrey score as a risk stratifier for alcoholic hepatitis and just 10% realised how high the mortality of the condition was during an acute admission. 49% appreciated that the specific medical management of alcoholic hepatitis was steroids or pentoxyphylline. 21% of respondants would have discharged a patient with severe alcoholic hepatitis (Maddrey 32) from hospital. Results of responses from Consultants alone were broadly similar to the above pooled results.
Conclusion The burden of alcohol-related health problems on the NHS cannot be understated. National statistics report over a million acute admissions where an alcohol-related disease, injury or condition was the primary reason for hospital admission or a secondary diagnosis, in 2009/2010—this is over double the number in 2002/2003. The results raise concern about the awareness of the management of alcohol related conditions among general physicians, especially the specific management of alcoholic hepatitis. Such patients thus suffer delays in diagnosis and management, possibly even increased morbidity; these delays lead to increased length of stay and repeated, expensive inpatient attendances. The role of the Gastroenterologist may be to be pro-active, rather than reactive in co-ordinating education, and service provision in this field. A guideline is in development locally that will be available to acute physicians via the intranet; it aims to simplify the managemet of alcohol-use disorder presentations. We aim to audit these presentations after introduction of the guideline and expect to show a significant improvement in standards.
Competing interests None declared.
Reference 1. Alcohol-Use Disorders. NICE, 2010. http://www.ias.org.uk/resources/ukreports/reports.html