Introduction In 2010/11 alcohol related harm cost the NHS in Lancashire £141.92 million, with Preston having the highest rate of hospital admissions for alcohol related liver disease in the North West. At that time there was no alcohol liaison team within Lancashire Teaching Hospitals. In view of this, in April 2013, the Hospital Alcohol Liaison Service (HALS) was created providing a seven day service for both the Royal Preston Hospital and Chorley and South Ribble Hospital.
Methods The HALS team comprises 4 senior nurses with experience in managing patients with alcohol and substance misuse. The referral criteria are patients scoring 8 or more on the Alcohol Use Disorders Identification Tool (AUDIT). A prospective database was created to include numbers of referrals, types of alcohol misuse, referring wards and departments, dates of admission and discharge, and the numbers of bed days saved. Data collected from April-October 2013 were analysed.
Results 808 patients were reviewed with 68% being male. The majority referrals were acute admissions, with 23% referred from the Emergency Department and 47% from the Medical Assessment Unit. Patients were reviewed within an average of 12 h since referral time (range 3–36 h). Delayed discharges were frequently identified in patients on a reducing regime of Chlordiazepoxide. The majority of patients were being kept in to complete this regime, regardless of whether they planned to stop drinking or not. On discharge, patients were not being offered follow up in the community which often led to recidivism and re-attendance at hospital seeking further detoxification. The HALS team reviewed and assessed these patients with validated assessment tools including the Severity of Alcohol Dependency Questionnaire (SADQ) and Clinical Institute Withdrawal Assessment Score (CIWA). The level of misuse was calculated as low risk in 127 patients, dependent in 382, harmful in 126, hazardous in 166, detox in 1 and unknown in 6 patients. Existing treatment regimes were reviewed to ensure they were appropriate and timely, and patients were identified for safe and early discharge with early community follow up. A total of 641 bed days were saved over the time period analysed.
Conclusion Implementation of a 7-day HALS team covering two acute hospital sites has significantly improved the quality of care provided to patients with alcohol-related disorders. In addition there has been a very positive impact on reducing length of stay and bed occupancy. Plans are in place to develop and audit the HALS team further and strengthen working relationships with community partners.
Disclosure of Interest None Declared.