Introduction The impact of Alcohol Specialist Nurse Teams in acute hospitals has been shown to reduce hospital admissions, violent incidents against staff and primary care attendances.^1,2 Indeed, one case study published by NICE demonstrated evidence of efficiency savings and improvements in quality of care. However, some studies have failed to replicate these findings, showing no significant impact on hospital utilisation.^3,4. Therefore it is important to identify the active ingredient to account for these differences. The evidence suggests that the more comprehensive and integrated the patient pathway is, the greater the effect. We therefore developed a bespoke competency framework for nurses to broaden their skill base and enable them to provide comprehensive pathways of care across community and hospital. Importantly we enhanced our service to include seven-day nurse-led out-patient provision, nurse prescribing and a consultant-led multidisciplinary team (MDT) approach.

Method Hospital episode statistics data were obtained for the 6 years post implementation of the Alcohol Specialist Nurse enhanced service. Data were obtained on; number of alcohol-related admissions, length of stay (LOS). Hospital electronic records provided data for ASNT activity.

Results We have shown a significant reduction of 17% in alcohol-related admissions from 4585 in 2011 to 3805 in 2016. In the same period new referrals to the ASNT reduced from 12.5 to 10.3 per day, with a corresponding increase in out-patient attendances from 1683 in 2014 to 2244 in 2016. A reduction in LOS of 2 days accounting for 5525 fewer bed days in 2016 when compared to 2015.

Conclusion In stark contrast to national increases in alcohol-related admissions, reported to be at a rate of ~3% in 2014/15, we have shown a significant reduction. This is reflected in a decrease in the number of referrals to the ASNT. Perhaps most important is the corresponding increase in out-patient attendance, which suggests that patients are adhering to and remaining engaged in their treatment pathway; commenced in hospital and continued as out-patients. Our enhanced integrated pathway of care supports nurses develop competencies that enable them to work across medical specialities and clinical settings, optimising both hospital care and aftercare.

References

1. . Ryder SD, et al. Clin Med (Lond) 2010;10(5):435–40.

2. . British Society of Gastroenterology: Reducing Acute Hospital Admissions and Improving Quality of Care, 2012. Available online at: https://arms. evidence.nhs.uk/resources/qipp/29420/attachment (Last accessed 19th May 2015).

3. . Currie C, et al. BMC Public Health 2016;16:685.

4. . Owens L, et al. Alcohol Alcohol 2016;51(5):584–92.

Disclosure of Interest None Declared