Introduction The National Health Service expenditure on alcohol services is estimated to be £2.7 billion with over 78% of costs incurred from hospital-based care.1Patients with alcohol problems are major contributors to hospital readmission,2reduction of which is also a key government objective. We aim to investigate the social and lifestyle factors that predict alcohol re-admissions.
Method Discharge summaries, case-notes and blood results were reviewed for patients requiring in-hospital Alcohol Detox (AD) between 1/10/2013 and 1/3/2014. They were then followed up to 1/8/2014. Data was collected on emergency Department (ED) re-presentation, hospital re-admission, community alcohol services (CAS) engagement, reasons for drinking alcohol and Childs-Pugh Score.
Results 189 patients were admitted and required input from alcohol liaison team, 76% (n = 144) of these required AD. Of these, 35% (n = 51 patients) required further admissions during the study period which accounted for 149 ED presentation episodes and 92 re-admission episodes. Within this cohort, admission in 58% (n = 30) of individuals were secondary to alcohol with 57 such episodes. Reasons for re-admission in this group included alcohol withdrawal symptoms (51%, n = 29), seizures (25%, n = 14), decompensated liver disease (14%, n = 8), gastrointestinal bleeding (n = 7) and alcoholic hepatitis (n = 3). Re-admission rates between this group and those admitted for other reasons and requiring AD was similar. Child-Pugh Score of A, B and C was noted in 71%, 14% and 15% of patients respectively. Identified social factors associated with alcohol excess were habitual alcohol consumption (82%), bereavement (4%), stress (28%), drug abuse (10%), social isolation (39%), unemployment (55%), started drinking at early age (65%) and CAS engagement (12%). Paradoxically admitting to alcohol dependence (51%, p < 0.001) and engagement with community alcohol services (12%, p = 0.04) led to higher chance of readmission and this could be due to greater healthcare seeking behaviour and awareness of their condition.
Conclusion This study identified social factors that associate with re-admission to hospital secondary to alcohol related diseases. Addressing these factors proactively may lead to better outcomes and reduction in hospital re-admissions for patients.
Disclosure of interest None Declared.
Alcohol related disease: meeting the challenge of improved quality of care and better use of resources (2010). A joint position paper by BSG/BASL/AHA. www.bsg.co.uk
NHS Confederation and Royal College of Physicians. Briefing 2010. Too much of the hard stuff: what alcohol costs the NHS. London: The NHS Confederation, 2010