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Providing a Cost Effective Alcohol Screening, Assessment
and Referral Service within a Hospital Setting
Mission StatementEnhancing the quality of life for people
in the Tees Valley by promoting sensible drinking patterns, raising the awareness
of alcohol and drugs and their effects, and by offering help to those suffering
from the effects of alcohol and drug misuse.
Introduction
• Established in1980
• Registered Charity no. 1103901
• Company Limited by Guarantee no. 5069305
• A Treatment, Counselling, Support, Advice, Information and Training service
for people affected by alcohol & drug misuse
Severely dependent
Moderatelydependent
Harmful drinkers
Hazardous drinkers
AUDIT 30+
AUDIT 24+
AUDIT 16+Triage/CoordinationTeam
GP PracticeIBA
Consider referral to Specialist Prescribing service
Direct referral to Specialist Prescribing service
The Problem
“For the NHS alone, the estimated financial burden of alcohol misuse is around £2.7 billion in hospital admissions, attendance at A&E, primary care, etc.
‘Signs for Improvement – Commissioning Interventions to reduce Alcohol related Harm’ Department Of Health
History of Primary Alcohol & Drugs Service
• PADS – University of North Tees Hospital 2001
• Counselling- 2 FTE Counsellors
• Maximum Case Load 36 patients
• Majority of referrals from the wards
• Invited back into hospital for counselling
• 8 to 12 counselling sessions offered
• Funded via the DAT and PCT
History of Primary Alcohol & Drugs Service
• PADS – James Cook University Hospital
• Established June 2006
• Two FTE Staff members plus admin support
• Not based on Counselling model
• Patients usually seen once for assessment/ IBA
• Train hospital staff on alcohol awareness, screening
tools and Identification & Brief Advice
Benefits of Voluntary Sector• Trained in counselling skills, motivational interviewing, IBA,
• Psychosocial approach
• Comprehensive holistic assessment of patients needs
• Quality time spent with patient (Not drawn into other duties)
• Involve Carers and relatives
• Advocate on behalf of patient
• Familiar with community services
• Cost effective
Achieved so far
• 1178 referrals (April 08 – March 09)
• 801 seen and assessed
• 114 already accessing services
• 301 new referrals to community services
• 95 hospital staff trained
• Supported by Hospital Managers, Consultants and Ward
sisters
• Psychiatry Liaison Team referral pathways agreed
Rate of alcohol admissions per 100,000 population and Projected Trend by SHA
500
1000
1500
2000
2500
2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11
Year
Ad
mis
sio
ns
North East
North West
Yorkshire and The Humber
East Midlands
West Midlands
East of England
London
South East
South East Coast SHA
South Central SHA
South West
Total for England
Rate of alcohol admissions per 100,000 population by PCT
0
500
1000
1500
2000
2500
3000
Year
Adm
issi
ons
Middlesbrough
Redcar and Cleveland
North Tees
Hartlepool
Average Total for 4 PCT's
What is the Government trying to achieve?
‘A reduction in chronic and acute ill-health caused by
alcohol, resulting in fewer alcohol related accidents and
hospital admissions than otherwise projected from 2008/09
baseline’
High Impact Changes within the Hospital
Department of Health recommends:
• High capacity, effective team
• Alcohol Liaison Nurse
• Targeting repeat admissions
• Identification & Brief Advice
• Importance of partnership working
High Impact – High Capacity
• Increased staff capacity• Medical and Psychosocial approach• Targeted times, including weekends• Continuation of treatment from hospital into community• More training to hospital staff
Position Hrs. Salary ActualAlcohol Nurse 37 31,856 31,856 Team Leader 37 24,250 24,250 Substance Misuse Worker 18.5 22,000 11,000 Substance Misuse Worker 18.5 22,000 11,000 Substance Misuse Worker 18.5 22,000 11,000 Substance Misuse Worker 18.5 22,000 11,000 Substance Misuse Worker 18.5 22,000 11,000 Admin Support 37 13,500 13,500 Total Salaries 124,606
National Insurance 12.0% 14,953
Pension 3% 3,738 Total Staff costs 143,297
Running Costs 7,900setting up costs 3,000
Central management & admin 22,489
Total 176,686
High Impact – Alcohol Liaison Nurse
•Grade 7 Prescribing Nurse
•Specifically treating alcohol dependant patients
•Liaise with community treatment service
•Develop prescribing regimes with community treatment service and
hospital
•Shorten length of stay in hospital for patients
•Joint visit with outreach service for those patients that do not engage
with community services
James Cook University Hospital Repeat Admissions
2007/08 2008/09
62 patients with 3+ Admissions including
59 Patients with 3+ Admissions including
Admissions Admissions
James Cook University Hospital Repeat AdmissionsSTATISTICS
• Specific alcohol diagnostic codes = 1391 (April- October 2009)
• 915 (65%) ward admission of less than 24 hours (644 individuals)
• And of this group 49 individuals resulted in 244 admissions of more than 3 admissions.
ACTIONS
• JCUH to create a CaMIS risk alert to identify when patient is admitted.
• Agree information sharing protocol with hospital
• Identify any other services engaged with these individuals
• Obtain alcohol treatment history
• Introduce a Case Conference/ Care Coordination group to specifically review care packages
• Invite all agencies who are involved or could have a support role
• Chairperson with the experience, authority and motivation to make plans happen
•Fresh look at what has been done and what can be done
•Proactive approach
•Look at underlying causes: housing, finance, mental health, lifestyle
•Consider : Detox, Residential Rehabilitation, Assertive Outreach,
Counselling, Support groups, Buddying Services, Care centres,
Supported Housing.
We need to get away from the “we have already tried that” mind set.
High Impact - Repeat Admissions
Thank you.
Any Questions ?