Introduction Worcestershire Acute Hospitals NHS Trust has an Alcohol Liaison Nurse Service (ALNS) across two hospital sites, with two full-time ALNs providing screening, case management support, brief interventions (BI) and referrals into community treatment services. We performed a retrospective cohort study to assess the impact of the ALNS on emergency departement (ED) re-attendance over a 3 year period and estimated the cost saving using the 2012/3 reference costs.
Methods All patients who had attended the ED, surgical or medical assessment units and received a BI delivered by the ALNS over a 3 month period, between January to March 2012, was identified via hospital records (Patient First ED computer system and OASIS). Patient attendances to ED for the preceding 12 month period were compared with the 12 month periods after the BI over the following 3 years. Patients were excluded if they lived outside the trust catchment area or were imprisoned or died during the study period. Costs of attendances to ED over the period were estimated as £114 per visit. Statistical analysis was by paired t-test.
Results 192 patients (123 males & 69 females) identified as having a BI were included in the cohort. 36 were excluded due to death within the study period and 4 due to incarceration. The median age of the cohort was 44 years (range 17–87 years). The most common reason for presentation related to mental health issues including deliberate self harm and overdose. During the 12 month period before ALNS intervention there were 464 qualifying ED attendances with an average of 2.42 attendances per patient. In the first 12 months following BI, the ED attendance rate fell to 327 (1.7 attendances/patient), and then to 255 in the second 12 months (1.33 attendances/patient), and finally 225 in the third 12 months following BI (1.17 attendances/patient).
The reduction in attendance was statistically significant 12 months after intervention compared with the preceding year (p < 0.005) and was sustained at 36 months post intervention (p < 0.005). Attendance for the third 12 month period post-intervention was statistically significantly lower compared with the first (p = 0.0181).
For this 3 month cohort of 192 patients, the cost of ED attendance in the year before BI was estimated at £52, 896. By the end of the study period this had been reduced by 51.5% (twelve monthly cost estimates £37,278, £29,070 and £25,650).
Conclusion This pragmatic study suggests that an ALNS may have a sustained effect upon the number and cost of ED attendances.
Disclosure of Interest None Declared
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