To stop people who experience drug and alcohol problems falling through the cracks, a charity is providing integrated services to complement NHS hospital care teams, writes Lynn Lawson
In the UK in 2012-13, there were 1,008,850 hospital admissions related to alcohol consumption where an alcohol related disease, injury or condition was the primary reason for hospital admission or a secondary diagnosis.
‘There are substantial numbers of patients with serious alcohol problems who are repeat attendees of hospital medical services’
Provision of alcohol services in emergency departments has been shown to be effective but there are substantial numbers of patients with serious alcohol problems who are repeat attendees of hospital medical services, usually presenting via medical assessment units. Many have potentially life threatening illnesses and consume substantial amounts of NHS resource.
Project 6 is a charity in Keighley that provides a range of integrated services for more than 3,000 people a year who are experiencing drug and alcohol problems. In 2007 the organisation became aware that problem drinkers who dropped out of service were being hospitalised, “detoxed” and discharged back into the drinking context where issues such as isolation, poor accommodation and poor relationships were leading to relapse.
As a voluntary organisation, Project 6 was able to swiftly respond by allocating resources to exploring the issue, establishing a foothold in Airedale General Hospital and engaging key people in addressing the need. In 2012 Project 6 received statutory authority funds to develop a secondary care team consisting of an accident and emergency worker and an alcohol crisis intervention team (ACIST) to work alongside NHS alcohol nurses as part of a hospital alcohol care team.
The services were established to provide a seamless, interlinking pathway of care for alcohol users across Airedale, Wharfedale and Craven, following a patient from screening, identification and engagement in a hospital setting out into their homes and the community.
Identification and engagement
Hospital staff on wards where alcohol problems are most likely to be identified - for example, A&E, medical assessment and gastro-intestinal wards – screen patients using AUDIT C, an alcohol screening tool. Patients who present conditions likely to be associated with hazardous, harmful or dependent drinking are those selected for screening for alcohol use.
Positive promotion by the team ensures that hospital staff are aware that the service can help patients make long term positive lifestyle changes upon discharge and 18,000 screenings were carried out in the hospital in 2014-15.
Patients identified as having problems are met on the ward by the ACIST workers who start to form a therapeutic alliance and elicit change talk, grasping the “teachable moment”, readying individuals for engagement in psychosocial interventions and helping to ensure retention in service.
The ACIST team carries out the essential post-discharge support to those patients who have experienced problematic alcohol use. In general, the majority of alcohol services rely upon the individual attending an appointment at a unit in a town centre. When this model is followed the most vulnerable in our society become lost.
Patients are visited in their homes as soon as possible on discharge and offered an intensive programme of therapeutic and practical support through a care plan which links them to a range of other relevant services. These can include mental health and social care services.
Outcomes and savings
In 2014-15 the A&E worker provided 856 brief interventions within the hospital while ACIST carried out 572 home visits, supporting 240 individuals who were unable to access town centre services.
In addition to helping with their alcohol dependence, practical support such as help with telephone calls, counselling for underlying issues, housing, establishing routine, and introducing new experiences is offered.
These interventions have a direct positive impact upon the health of the service user; when life is more stable you care more about your health. As a community based organisation Project 6 has an in-depth knowledge of community services that can be involved in building a holistic care plan.
Secondary care services are now established in the new A&E department at Airedale. Alongside the main work of screening and psychosocial interventions, the service is responsible for alcohol harm reduction materials in the A&E waiting room. This includes a state of the art instantly accessible harm reduction video.
‘These interventions have a direct positive impact upon the health of the service user’
Figures provided by the hospital show that the work carried out by ACIST is reducing the number of hospital attendances by our target group. A snapshot provided by the hospital for 19 individuals shows a reduction of 97 A&E attendances or hospital admissions at a cost saving of approximately £70,000.
A further result of this initiative has been the development of the recurrent attendees meetings at Airedale. It is hoped this work can be used with targeted individuals to measure the savings to the hospital care trust that this work makes.
Going forward, the aim is to increase the effectiveness of this work still further by engaging with multidisciplinary teams in GP surgeries and at Airedale to ensure that the services are aimed at individuals who are intensive users of medical services.
Lynn Lawson is director of development and communications for Project 6