Tim Wilson: Examining alcohol admissions at A&E
As part of our research programme at Wilson Drinks Report we observed admissions to A&E from 10pm to 2am.
We estimated that fewer than 10 per cent of admissions were clearly caused by alcohol, and all the staff involved in delivering front line services (e.g. A&E admissions, nurses, ambulancemen and police) seemed well-trained, motivated and professional. This included mopping up when drunken patients brought into A&E responded by vomiting whilst lying on a trolley.
The systems supporting the A&E process, however, seemed inadequate for the task. Multiple systems were not integrated which meant that large amounts of time were spent re-keying data from one system into another. There was also no facility for the A&E admissions staff to record whether any new patient appeared to be under the influence of alcohol or not.
Most drunks were classified as "collapsed" if there were no other injuries or conditions to record. The A&E staff said that there is no national requirement to collect data on alcohol-related admissions. This does beg the question of how the nationally reported statistics are arrived at.
Everyone we spoke to was in favour of some form of financial charge being levied on patients presenting to A&E as a result of being drunk. However it was also agreed (unanimously) that this would be impossible to implement in practice.
Ambulance service technicians said they often had "repeat customers, often three times in two weeks" and that some enterprising patients who live near the hospital used the ambulance as a taxi service - ie pretend to be drunk and injured, call 999 for an ambulance, get a lift back to A&E and then disappear.
Other insights from the staff included identifying easy access to cheap alcohol as being the main cause of drunkenness. The level of drink-related admissions to A&E depends significantly on the weather: long, hot sunny days leads to a big rise in A&E admissions. Wet evenings mean that drinkers tend to stay at home.
The innovative "Drunk Tank" initiative set up by the West Midlands Ambulance Service in Birmingham was cited as best practice, where volunteer doctors and nurses from the Central Accident Resuscitation (CARE) team man a temporary minor injuries unit in the city centre to deal with alcohol-related injuries, relieving the pressure on the local A&E departments.
The over-riding impression we left with was that the front-line staff were really dedicated, the systems were poor but the level of drink-related admissions was much less than we had expected.
