Most Weekend ED Attendances in UK Hospital Alcohol-Related

Ricki Lewis, PhD

December 22, 2015

Analysis of the prevalence and temporal pattern of alcohol-related visits at the emergency department (ED) of a large, inner-city hospital in northeast England confirms this burden is considerable and costly, suggesting such visits present an opportunity to intervene, according to study results published online December 21 in the Emergency Medicine Journal.

Kathryn Parkinson, PhD, from the Institute of Health and Society, Newcastle University, United Kingdom, and colleagues designed a dual retrospective and prospective cohort study to assess the burden of alcohol-related attendances on the ED. They collected data from paper and electronic hospital records from 4 weeks (in February - March, July, October, and December) during 2010 to 2011, to represent all seasons, and followed-up a year later to identify care delivered. The investigators searched records for the terms "alcohol" or "intoxication" or mention of consuming a specific beverage.

In the prospective group, the researchers assessed breath alcohol concentration in patients presenting to the ED who gave verbal consent during the corresponding weeks in 2012 to 2013. The team identified predictors of alcohol-related attendances by dichotomizing findings in positive (any alcohol) and negative cases and using this as the dependent variable. Independent variables were age group, sex, day and time of presentation, and geographic area.

Week of presentation at the ED was not significant. However, the 498 people who tested positive for alcohol on the breath test were more likely to be from out of town (odds ratio, 1.92; 95% confidence interval, 1.30 - 2.83).

The retrospective group of the study considered 5121 adult patients, 636 (12.4%) of whom had alcohol-related visits, and the prospective group included 6526 adult patients, 720 (15.2%) of whom had alcohol-related attendances. The increase over time may have been a result of an organizational change at the hospital, the researchers write.

Men between the ages of 18 and 24 years made up the majority of the alcohol-related visits. The top reasons for alcohol-related ED visits were traumatic injury and psychiatric problems.

The temporal pattern of visits was particularly telling. During the 4 weeks of 2012 to 2013, alcohol-related attendance rate varied from 4% to 60% on weekdays, but increased to 71.9% at weekends. Peak time of general attendance at the ED was midnight to 3 AM, but alcohol-related attendances peaked between 2:00 and 3:00 AM (59.0%).

In the part of the study that followed up on retrospective patients 12 months after the alcohol-related attendance, 102 (16.0%) of the 636 had been admitted to a ward or observation unit. The mean cost per attendance was from £249; the mean cost per admission was £850. Most individuals incurred only the median attendance cost (£112), indicating that a few patients were frequent visitors to the ED.

The researchers estimate that the cost for the ED in this one hospital could be approximately £1,000,000 per year for alcohol-related attendances, not counting ambulance and police work.

"This indicates a significant [National Health Service (NHS)] burden if all such EDs in the UK are sustaining similar demands associated with alcohol related attendance," the researchers conclude. The researchers offer specific suggestions for reducing the effect of alcohol-related attendances on the cost and functioning of the ED:

  • add staff for weekends, particularly mental health professionals;

  • provide brief intervention at the time of attendance; and

  • train paramedics to handle patients with alcohol-related injury or illness before transfer to the ED.

A limitation of the study is that sober patients were more likely to agree to a breathalyzer than intoxicated patients.

In an accompanying editorial, Clifford Mann, MD, emergency care consultant at Taunton and Somerset NHS Foundation Trust and president of the Royal College of Emergency Medicine, calls the study results "a timely reminder of the impact and burden of alcohol on emergency departments." He points out that the 1 million annual alcohol-related hospital visits in England cost the NHS £3.5 billion.

Dr Mann attributes the 100% increase in alcohol-associated hospital admissions from 2003 to 2013 to "preloading" (drinking before going to pubs), the relaxation of licensing laws in 2005, and the low cost of alcoholic beverages, which are cheaper than bottled water. Despite these trends, the response of governments to the financial burden of alcohol use has been "woefully inadequate," he writes. Dr Mann proposes a minimum unit price for alcoholic beverages.

The study grant was awarded by the Newcastle upon Tyne Hospitals NHS Foundation Trust: Flexibility and Sustainability Funding. The researchers and editorialist have disclosed no relevant financial relationships.

Emerg Med J. Published online December 21, 2015.

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