Robin Touquet

Screening and referral for brief intervention of alcohol-misusing patients in an emergency department: a pragmatic randomised controlled trial.

BACKGROUNDnAlcohol misuse is highly prevalent among people attending emergency departments, but the effect of intervention by staff working in these departments is unclear. We investigated the effect of screening and referral of patients found to be misusing alcohol while attending an emergency department.nnnMETHODSnWe undertook a single-blind pragmatic randomised controlled trial. Patients received either an information leaflet or an information leaflet plus an appointment with an alcohol health worker. Outcome data were collected by patient interview and examination of hospital records at 6 and 12 months.nnnFINDINGSn599 patients were randomised over a 12-month period. At 6 months, those referred to an alcohol health worker were consuming a mean of 59.7 units of alcohol per week compared with 83.1 units in the control group (t -2.4, p=0.02). At 12 months those referred were drinking 57.2 units per week compared with 70.8 in controls (t -1.7, p=0.09). Those referred to the alcohol health worker had a mean of 0.5 fewer visits to the emergency department over the following 12 months (1.2 compared with 1.7, t -2.0, p=0.046). Differences in quality of life were not found.nnnINTERPRETATIONnOpportunistic identification and referral for alcohol misuse in an emergency department is feasible, associated with lower levels of alcohol consumption over the following 6 months, and reduces reattendance at the department. Short-term reductions in alcohol consumption associated with referral for brief intervention for alcohol misuse benefit patients and reduce demand for accident and emergency department services.

Improving detection of alcohol misuse in patients presenting to an accident and emergency department

Objectives—To assess and improve deployment of a brief test for alcohol misuse: the Paddington Alcohol Test (PAT). Design—Prospective study of the effects of audit feedback. Setting—An urban accident and emergency department. Subjects—Senior house officers (SHO) (n = 13). Outcome measurements—PAT use and categorisation of patients for each SHO; observational analysis of presenting complaints according to PAT. Results—1062 of 1737 patients (61.1%) were defined as PAT possible—that is, presented with ≥ one complaint listed on the PAT test proforma. In month 1, PAT uptake was poor. PAT use improved significantly when feedback was instituted (p<0.0001). The response to audit and feedback showed marked inter-SHO variation. When feedback was withdrawn (month 4), there was a significant reduction in PAT use (p=0.003). Three other indices of detection followed this trend: (a) number of PAT positive patients identified, (b) proportion of PAT possible patients identified as PAT positive, and (c) number of PAT positive patients referred to the alcoholic health worker. The 10 most common PAT positive categories, accounting for 77% of all PAT positive complaints were: fall > collapse (including “fit”, “blackout”) > head injury (including “facial injury”) > assault (including “domestic violence” and `other) > non-specific gastrointestinal problem > “unwell” > psychiatric (including “depression”, “overdose”, “confusion”) > cardiac (including “chest pain” and “palpitations”) > self neglect > repeat attendance. Conclusions—Ongoing audit with feedback improves both PAT use and detection of alcohol misuse. The PAT is now simpler including only 10 conditions, which should further aid its use.

PAT (2009)--revisions to the Paddington Alcohol Test for early identification of alcohol misuse and brief advice to reduce emergency department re-attendance.

The Paddington Alcohol Test (PAT) has evolved over 15 years as a clinical tool to facilitate emergency physicians and nurses giving brief advice and the offer of an appointment for brief intervention by an alcohol nurse specialist. Previous work has shown that unscheduled emergency department re-attendance is reduced by ‘making the connection’ between alcohol misuse and resultant problems necessitating emergency care. The revised ‘PAT (2009)’ now includes education on clinical signs of alcohol misuse and advice on when to request a blood alcohol concentration.

Tackling alcohol misuse at the front line.

Training staff where patients usually present should improve detection and advice

The 10 commandments of accident and emergency radiology.

EDITOR,--A H Troughton and I Kendall1 and T F Beattie and colleagues2 comment on our article giving 10 commandments of accident and emergency radiology.3 As we stated in the introduction, the article was written for inexperienced senior house officers working in accident and emergency departments. The authors of the letters either did not read this or are unaware that, commonly, inexperienced accident and emergency doctors work without direct supervision.4nnIn answer to Troughton …

Challenges and solutions in implementing screening and brief interventions for hazardous alcohol use in accident and emergency departments

The SIPS study is a major UK evaluation of screening and brief intervention strategies for nalcohol users in primary care, emergency departments and criminal justice settings. Here we npresent the results of a pilot study of screening tools and the main study screening results in nprobation settings. In the pilot study 592 individuals in a variety of settings where approached nand 205 consented to take part in the study. The screening tools being evaluated were the nmodified Single Alcohol Screening Questionnaire and the Fast Alcohol Screening Test. The nGold standard comparison was AUDIT. The mean age in the pilot study was 31 years (SD 9) nand the majority were male. The overall prevalence of alcohol use disorders in the population nwas high at 70% with almost 50% at the dependent end of the spectrum. Those scoring npositive on AUDIT had significantly poorer overall health status and were greater users of nhealth and criminal justice services. A ROC analysis of the instruments demonstrated high nsensitivity and specificity for both M-SASQ and FAST and ROC analysis indicated a marginal nsuperiority of FAST over M-SASQ (AUC 0.97 vs. 0.92). The main study is a pragmatic nfactorial randomised controlled trial set in probation services in the UK. The study compares nscreening tool (FAST vs. M-SASQ) and 3 brief interventions (Patient information leaflet vs. nBrief advice vs. Brief Lifestyle Counselling). A total of 976 individuals were approached and n854 were eligible and screened with 573 screening positive. The initial results indicate a high nprevalence of alcohol use disorders in this population (68%). The sensitivity of M-SASQ and nFAST was high (81% vs. 92%) but FAST appears to be more sensitive than M-SASQ at nidentifying those with more severe alcohol use disorders with an odds ratio for FAST versus nM-SASQ of 2.69 (CI 1.55–4.67) for all alcohol use disorders and 1.58 (CI 1.11–2.24) for nharmful alcohol use disorders. FAST appears to be the most efficient screening mechanism in nthis population but we do not yet know how the screening mechanism interacts with the ntreatment intervention.

Individual and organizational determinants of alcohol screening and brief intervention implementation in emergency departments (SIPS-ED)

35th Annual Scientific Meeting of the Research Society on Alcoholism, June 23-27. San Francisco, California