New studies reveal rise in alcohol screening for adults attending Emergency Departments but more help needed for young and vulnerable

New research published today (4 May) by Alcohol Research UK shows that while more adults are being routinely screened for alcohol-related problems in Emergency Departments in England more specialist support is needed to help young people and the vulnerable.

A new study by researchers based at the University of Surrey, funded by Alcohol Research UK, shows that Emergency Departments in England have increased the level of alcohol screening for adults – with the offer of specialist support for those attending with alcohol-related health problems and for those who frequently attend.

However, while most Emergency Departments attending to under-18s ask them about their drinking few do so routinely. This needs to improve to ensure young people considered to be at risk of developing drink-related ill health receive the specialist support they need.

Key findings from the study ‘The Third National Emergency Department Survey of Alcohol Identification and Intervention Activity’ show that:

  • Almost two-thirds (63.6%) of adults are routinely questioned about alcohol use (compared to 47.7% in 2011).
  • Routine questioning about alcohol use among under-18s remains limited, with 11.6% being routinely asked about their drinking (up from 8.9% in 2011).
  • Access to Alcohol Health Workers or Clinical Nurse Specialists has increased by 13.4% since 2011 to 85.2% for adults displaying alcohol-related problems.
  • Forty per cent of emergency departments have ‘assertive outreach’ strategies in place to tackle frequent attendance by adult patients affected by alcohol-related problems.
  • Improved communication between Emergency Departments and GPs about alcohol-related attendance highlights a move towards multidisciplinary care, with 85% (compared to 74.8% in 2011) of GPs now routinely informed.

This latest survey provides important data on current levels of screening and further evidence of how the management of patients in Emergency Departments with harmful drinking behaviour can be improved.

Dr Bob Patton, from the University of Surrey and lead author of the study, said:

“We carried out a survey of all consultant-led Emergency Departments in England to explore the implementation of alcohol identification and brief advice (IBA) for adult and adolescent patients, with an additional focus on older drinkers and people frequently attending for alcohol-related issues. The response rate for the survey was over 80%.

“Our report shows that, in comparison to the previous 2011 survey, changes in alcohol IBA activity remain positive. Routine questioning about alcohol consumption (in adults), the number of GPs being informed by departments about patients’ alcohol-related attendances, and access to specialist nurses have all significantly increased. Additionally, modest increases in the provision of training on alcohol IBA, and the use of a formal alcohol screening tool on adult attendees have been observed.”

The full report ‘The Third National Emergency Department Survey of Alcohol Identification and Intervention Activity’ is available online.

Supporting vulnerable people

In a separate study by King’s College London, new research shows that people who repeatedly present to Emergency Departments with alcohol problems have multiple and complex needs that require more personalised support.

The qualitative study, funded by Alcohol Research UK and soon to be published as an open access paper in the journal Drugs: Education, Prevention and Policy, found that people who frequently attend Emergency Departments have:

  • diverse patterns of drinking and other substance use;
  • varied health and social problems (and resources);
  • mixed housing circumstances; and
  • different demographic characteristics.

The study reports that providing intensive and individualised support for patients in the community, known as ‘assertive outreach’, could offer a better solution for helping people who frequently attend Emergency Departments for alcohol-related reasons. This type of personalised support has the potential to be flexible enough to respond to individual patient needs and circumstances.

The study recognises that Emergency Department staff need resources and training to enable better care management for this vulnerable group; yet Emergency Departments are ultimately not likely to be the most suitable setting to help people with complex drinking problems and a mixture of other personal and social difficulties.

Dr Joanne Neale, lead researcher at King’s College London, said: “Whilst we need to increase resources for people who frequently attend Emergency Departments for alcohol-related reasons, we must also recognise that they are all individuals who have very different needs and resources. We must therefore avoid stigmatising terminology and overly simplistic generalisations that assume people are all the same.”

Researchers at King’s College London carried out in-depth qualitative interviews to increase understanding of the demographic characteristics, substance use, social circumstances, and patterns of patients who frequently attend Emergency Departments for alcohol-related reasons.

Interviews were conducted with 30 individuals, from six hospitals in Greater London, who had attended Emergency Departments 10 or more times within the last year or five or more times within the last three months for an alcohol-related condition.

Focus groups were also conducted with 44 Emergency Department staff who worked in six hospitals across England.

A summary of the research is available online.

Dr James Nicholls, Director of Research and Policy Development at Alcohol Research UK, said:

“Accident and Emergency Departments often form the frontline in dealing with alcohol-related harms.  This research confirms the importance of establishing systems that can help staff when dealing with alcohol-related admissions. It is very encouraging to see that Emergency Departments are increasingly identifying people who may benefit from brief advice about their drinking, as this provides a real ‘teachable moment’ with the potential to have an impact on drinking behaviours.

“The research from King’s College London, however, highlights the lack of other services for very heavy drinkers can mean increased pressure on department staff.  While Emergency Departments provide an opportunity to intervene effectively in drinking problems, staff need the necessary support to achieve this and robust systems need to be in place to either deliver advice or refer people onto specialist support. The vital role of Emergency Department staff in addressing alcohol harms needs to be properly acknowledged, and this research helps us better understand how to support their work.”

For further observations on these studies read Dr James Nicholls’ blog post.