Examining the identification and management of alcohol withdrawal admissions to acute hospitals

BackgroundAlcohol related admissions to acute hospitals in England are increasing, resulting in unmet need in terms of identification and management of alcohol withdrawal (AW) outside of specialist addictions settings. Early detection, monitoring and treatment of AW is crucial in reducing risk of mortality, and optimising treatment resulting in fewer complications.AimThis thesis aimed to examine how AW is identified and managed in acute hospitals.MethodsA systematic review of identification of AW was conducted as well as analysis of Hospital Episode Statistics (HES) Data to explore demographic and clinical predictors of AW and a detailed clinical audit of AW admissions in an acute hospital.ResultsThere is no systematic application of screening tools or approaches to identifying AW in acute hospitals. Patients with an ICD-10 AW diagnosis are significantly more likely (compared with all other diagnoses) to be male, White British, admitted as an emergency, admitted on a weekend and live in areas of high deprivation. Adherence to administration of AW medications varies, and prescribing of benzodiazepines does not adhere to NICE recommendations with regards to quantity and frequency of alcohol consumption; and onward referral rates to specialist community alcohol services are low.DiscussionThis work will inform the delivery of hospital-based alcohol care supported by Alcohol Care Teams as prioritised by NHS England, by highlighting areas where energies could be focussed to improve identification and management of AW patients in acute hospitals. Key areas to focus on would be a standardised approach to universal screening and identification of alcohol use disorders, exploring those predictors of AW to establish the mechanisms behind those findings (e.g. why weekend admission is significantly associated with AW), and improving delivery of care for admitted patients in terms of medication adherence, monitoring and surveillance of AW syndrome, contact with alcohol specialists and engagement with community teams.