Introduction Alcohol-related harm costs the NHS £3.6 billion per year, of which 78% is costs to the hospital.1 Alcohol is traditionally poorly coded in UK hospitals and so estimating alcohol-related admissions and the resources they consume can be challenging. Underestimation may adversely influence service requirements and underestimate the impact of cost reduction measures.
Methods Hospital admissions to a Central London Hospital for a 101 day period were identified from four sources:
A search of 25 alcohol-related ICD-10 discharge diagnosis codes;
Patients reviewed by the alcohol liaison nurse;
All CT Head scans completed were analysed for evidence of alcohol misuse;
Patients attending The Accident and Emergency Department (A&E) with alcohol misuse.
Results Over this 101 day period, 537 admissions in 349 individual patients with harmful/hazardous alcohol use were identified with a total of 2,855 inpatient bed days and 104 day case procedures. 237 (44%) of these admissions did not have an alcohol-related discharge code. The mean admission length was 5.3 days. Fifty-eight percent of these patients had presented to the hospital at least once in the previous year with a total of 914 attendances, resulting in 518 admissions. This estimates 1,941 admissions per year in patients who drink to excess and a total of 10,318 inpatient bed days, equating to 28 inpatients per day. Eighty percent of these were emergencies accounting for 9.5% of all emergency admissions to the hospital.
The table lists the resources used by this cohort both during the index admission and over the past 12 months:
Over the same period, A&E ordered 464 CT Head scans, of which 112 (24%) were due to alcohol with head injuries being the commonest indication (34.4% alcohol-related). Alcohol was involved in 133 (22.2%) scans done within 24 hours of admission, estimating almost 500 scans per year.
Conclusion Our data demonstrates that alcohol admissions are poorly coded and therefore the extent of alcohol-related resource use is likely to be an underestimation. We expect there to be further admissions not picked up using the above methods. Alcohol-related admissions account for high resource use and the costs, in bed days alone, exceed £3,500,000 per year in a single hospital. Accurately coding admissions is crucial to ensure that this group of patients, with high resource use, can be identified so that measures can be taken to treat their alcohol misuse and reduce the burden on healthcare.
Reference 1 Statistics on Alcohol: England, 2013. Health and Social Care Information Centre. 2013.
Disclosure of Interest None Declared