Introduction Alcohol-related harm costs NHS £3.5 billion a year. It has become a “top priority” for the NHS. Alcohol Concern reported 1.2 million alcohol-related admissions in 2011/12, an increase of 135% over the last 10 years, but more people are also seeking and completing treatment. Current standard treatment for those actively withdrawing from alcohol is for inpatient (IP) detoxification and concurrent assessment and intervention by an Alcohol Liaison Nurse (ALN) which usually takes, on average, 5–7 days as an IP.
Methods A care pathway was formulated for inpatients to be referred to the AC service based on strict guideline. The AC centre dedicated 2 appointments daily within working hours (Mon-Fri) for outpatient (OP) detoxification. During each session, the ALN assessed, breathalysed the patient and completed a Clinical Institute Withdrawal Scale (CIWA). The AC doctor then prescribed a daily regimen of chlordiazepoxide on a symptom-dose basis. A retrospective audit was completed of all patients referred through this pathway.
Results From Jan 13-Dec 13, 19 patients (after medically assessed) were referred for the ACAD after 3 days. 14 patients engaged with the service and completed their AD. 10 male, 4 female, aged 28–68 years. All patients were admitted via Emergency Dept; 8 presented with alcohol withdrawal, 6 with other acute problems but concurrently treated for alcohol withdrawal whilst IP. 10 had physical co-morbidities; 2 had psychiatric co-morbidities. 6 patients had a previous history of seizures. 2/14 patients consumed alcohol during the AD phase of their treatment (noted on breathalysing the patients). These patients were subsequently discharged from ambulatory care and referred to local alcohol services. 1 patient required readmission to hospital for physical concerns relating to diabetes, completing the remainder of the detoxification as an IP. All patients agreed to be followed up in the community and have engaged with community services. The average duration of AD was 5 days. In previous study we have estimated that a 7 day inpatient admission as costing £2183 vs a 3 day admission with 3 follow up ambulatory appointments costing £1352. The potential cost saving is significant once this service is widely used.
Conclusion This small innovative pilot study demonstrates that ACAD can be an effective and safe approach to the managing acute alcohol withdrawal; enable continued monitoring of vulnerable patients in a controlled OP environment. There is a need for a paradigm shift of offering AD in AC setting rather than IP treatment. Further patients are beibng recruited into an ongoing study.
References Public Health England, Alcohol Treatment in England 2012-13
Alcohol Concern, www.alcoholconcern.org
Barry et al., Alcohol Inpatient Detox: Withdrawing the burden of inpatient management. Gut, 2013
Disclosure of Interest None Declared.