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Zara Quigg: Violence and TIIG Research Manager
Centre for Public HealthWHO Collaborating Centre for Violence Prevention
Alcohol-related data collection in emergency departments: The Wirral model
ObjectivesObjectives
• Trauma and Injury Intelligence Group (TIIG)• The Wirral Model
– Alcohol-related attendances– Reporting mechanisms– Interventions– Outcome
• TIIG development across the North West
TIIGTIIG
• Funding: local partners
• Injury surveillance system
– Intentional / unintentional
• Informing injury prevention strategies
• Brings together a variety of data sources
• Focus: ED data sharing
Childhood injuries
Falls
Violence / alcohol
4/4
5/5
6/6 12/12
4/4
ED data ED data Existing data items
– Injury group Assault, sports injury, RTC, self harm
– Patient demographicsGender, age, area of residence
– Date / time of attendance– Location of incident
e.g. public place / home– Arrival / referral method– Disposal method (e.g. admitted)
Additional fields
ViolenceCore
1. Time / date2. Location assault (e.g. pub name)3. Assault type (e.g. weapon used)
Enhanced
4. Relationship with attacker5. Number of attackers 6. Gender of attackers 7. Reported to the police8. Attacker consumed alcohol9. Motive
Expansion of existing fields- Injury group: Fall / burns- Location: where in the home
- e.g. Kitchen / stairs
Additional fields
Alcohol
1. Had you been drinking alcohol within three hours prior to the incident occurring?
2. Where did you consume / purchase your last drink?
The Wirral ModelThe Wirral Model
Figure 1: Proportion of injury attendances that are alcohol-related by year, Arrowe Park ED
• ED data collection 02/03 (baseline 03/04)• PCT / CSP strategies
Target: reduce alcohol-related assault attendees by 15% over three years
The Wirral ModelThe Wirral Model
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
20.012
.00
- 13
.59
14.0
0 - 15
.59
16.0
0 - 17
.59
18.0
0 - 19
.59
20.0
0 - 21
.59
22.0
0 - 23
.59
0.00
- 0
1.59
02.0
0 - 03
.59
04.0
0 - 5.
59
06.0
0 - 07
.59
08.0
0 - 09
.59
10.0
0 - 11
.59
Time group (hr)
Perc
enta
ge
Sunday
Friday
Saturday
Figure 2: Assault attendances by time and day of attendance, Arrowe Park ED 2008/09
• 40% of assault cases have been drinking
• 74% between 2am and 4am weekend nights
The Wirral ModelThe Wirral ModelFigure 3: Proportion of attendances to Arrowe Park ED identified as alcohol-
related, under 18s only by age, Arrowe Park ED, 2007/08
The Wirral ModelThe Wirral Model
Age
Gender
Alcohol Circumstances Outcome
13 Male 2-3 litres Cider
StreetWith friendsPurchased from shopDrank previously Birthday
DischargedReferred to RESPONSE
13 Female
3 glasses wine (Lambrini)
StreetWith friendsPurchased from shopDrinks regularlyKnown repeat attendeeFriends drinking
Assault-related injuryAdmitted to hospitalSafeguarding concerns identified - referred to social services
15 Female
4 units Cider
ParkWith friendsDrank previously Socialising
Referred to Paediatrics for observation overnightHead injury assessmentNo injuries identified
14 Female
2 glasses wine (Lambrini)Offered Whizz and vodka
StreetWith friendsObtained from friendsDrank previouslyPeer pressure to drink and fight
Assault-related injury DischargedSafeguarding concerns identified - referred to social services
15 Female
Cider / Alcopop
House partyWith friendsObtained from friendsHouse party
Assault-related injuryAdmitted to hospitalSafeguarding concerns identified - referred to social services
Table 1: Alcohol-related attendances by demography, alcohol consumed, circumstances surrounding
consumption and outcome, Arrowe Park ED
Two week alcohol audit
• Electronic data collection identified 13 alcohol-related attendees (<18)
• 1.6% of all attendees
•Audit identified 5• Female• Cider / Lambrini• Drank in street / park•Purchased from shop•3/5 admitted to hospital
Tackling Knives Action Programme (TKAP) project to Enhance Violence Prevention
through ED Data Sharing
[Wirral BCU (Arrowe Park data only)]
Overview of ED Data
[10/05/10 to 23/05/10]
InjuriesVolume in
reporting periodAverage
age Male FemaleVariation on previous
period
Knife related 0 - - - -1
Other sharp implement 0 - - - Same
Gun related 0 - - Same
Blunt implement 1 19 1 - -2
Physical assault (no weapon) 33 25 26 7 Same
Glass 2 21 1 1 +1
Other 0 - - - Same
Unknown/refused to answer 2 32 2 -2
‘Hot’ Locations in Reporting PeriodLocation Weapon Date/Time of assault N AggregateWoodville Road Bottle 10/05/10 / 10/05/10 09:45/ Unknown 2 5New Brighton Promenade 14/05/10 / 22/05/10 23:00 / 22:15 2 2Birkenhead Central Train Station 14/05/10 15:30 1 2Borough Road 23/05/10 17:45 1 3Bebington Road 15/05/10 07:00 1 1Ben Nevis Road Unknown Unknown 1 1Bentinck Street 22/05/10 03:00 1 1Bidston Leisure Centre 12/05/10 20:30 1 1Bidston Moss B&Q 19/05/10 08:30 1 1Chamberlain Street 20/05/10 20:30 1 1Grange Place 20/05/10 18:30 1 1Hoole Road Blunt Object 16/05/10 17:30 1 1Larch Road Unknown Unknown 1 1Neston Kebab House 23/05/10 01:30 1 1North End 13/05/10 23:00 1 1Pembroke Court 11/05/10 16:30 1 1RJs 23/05/10 13:00 1 6Seabank Road 15/05/10 22:00 1 1St Caths Hospital O/S 22/05/10 22:30 1 1St John Plessington School 13/05/10 Unknown 1 1St Pauls Road Bottle 22/05/10 21:00 1 1Ward 18 APH 13/05/10 01:40 1 1West Kirby Train Station 22/05/10 21:00 1 1Whiteheath Way 18/05/10 21:00 1 1
Violence occurs in Town and City Centres yet perpetrators and victims live elsewhere
Assault Presentation to
Accident & Emergency by Deprivation of
Residence
ReportsReports
InterventionIntervention
CCTVStreet Lighting Licensing Alleygates
• Development, implementation and monitoring of local alcohol and violence
prevention strategies / prevention initiatives
• Targeted policing and licensing enforcement
• AMEC / TCVP / TKAP
• Pubwatch
• Best Bar None / Think 21 campaign
• Targeted social marketing campaigns
Event Planning
PreventionPrevention
• England match days (EMD)• 33% increase assault
attendances• Saturday / Thursday
• 50%• No increase during World Cup period only (accounting for EMD)
Operation XchangeOperation Xchange
• Partnership approach– ED, police, primary care– 14th to 23rd Dec 2009– ED data used to guide police
operation – Targeted policing / licensing
enforcement
• Outcomes– 3 knives recovered – 21% reduction in wounding
offences within the city centre
– 57% reduction in ED assault attendances
10
12
14
16
18
20
22
24
AMEC weeks for 2005/06
Non-AMEC weeks
Rat
e of
ass
ault
att
enda
nces
/wee
k
2002/03 2003/04 2004/05 2005/06
Financial Year
AMEC 2005/06
Licensing Act and Alcohol Misuse Enforcement Campaign
EvaluationEvaluation
Arrowe Park, Wirral: 03/04 - 09/1003/04 = 3,299 / 1,48509/10 = 2,035 / 975 (38% / 34% reduction)
TrendsTrends
Est. £40,800 saved (PCT) through reduction in ED alcohol-related assault attendances
Est. £24,000 saved (provider) through reduction in alcohol-related assault admissions
North West data collection / sharingNorth West data collection / sharing
Area Violence Alcohol
Cumbria 2/3 2/3
Cheshire 1/4 1/4
Greater Manchester 7/12 4/12
Lancashire 2/5 2/5
Merseyside 5/7 5/7
North West 17/31 14/31
Number of EDs collecting and sharing alcohol and violence data with TIIG, by area
Contact details
For and more information please contact:
Zara Quigg, Violence and TIIG Research Manager0151 231 4359, [email protected]
www.tiig.info
Centre For Public HealthLiverpool John Moores University
WHO Collaborating Centre for Violence Prevention5th Floor, Kingsway House, Hatton Garden, Liverpool, L3 2AY