Educating Emergency Department Registered Nurses in Screening, Brief Intervention and Referral to Treatment

Mitchel, A.M. et al. International Emergency Nursing. Published online: December 17 2016

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Highlights

  • SBIRT has been shown to be effective in reducing risky alcohol consumption.
  • Patients trust nurses, underscoring nurses’ ability to have a positive impact.
  • EDRNs can increase their knowledge and attitudes to routinely screen patients for risky substance use.
  • SBIRT training and educational reinforcement is key for continued implementation.

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Impact of alcohol abuse on the emergency services

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The All-Party Parliamentary Group on Alcohol Harm has published The Frontline Battle.

This report presents the results of an inquiry into the impact of alcohol on emergency services. It sets out the extent of the pressures and dangers of alcohol related problems placed on the emergency services and discusses the impact on staff, the impact on service provision and the effect on time and resources.

Quantifying alcohol-related emergency admissions in a UK tertiary referral hospital

Vardy, J. et al. BMJ Open. 2016. 6:e010005

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Objectives: Alcohol is responsible for a proportion of emergency admissions to hospital, with acute alcohol intoxication and chronic alcohol dependency (CAD) implicated. This study aims to quantify the proportion of hospital admissions through our emergency department (ED) which were thought by the admitting doctor to be (largely or partially) a result of alcohol consumption.

Setting: ED of a UK tertiary referral hospital.

Participants: All ED admissions occurring over 14 weeks from 1 September to 8 December 2012. Data obtained for 5497 of 5746 admissions (95.67%).

Primary outcome measures: Proportion of emergency admissions related to alcohol as defined by the admitting ED clinician.

Secondary outcome measures: Proportion of emergency admissions due to alcohol diagnosed with acute alcohol intoxication or CAD according to ICD-10 criteria.

Results: 1152 (21.0%, 95% CI 19.9% to 22.0%) of emergency admissions were thought to be due to alcohol. 74.6% of patients admitted due to alcohol had CAD, and significantly greater than the 26.4% with ‘Severe’ or ‘Very Severe’ acute alcohol intoxication (p<0.001). Admissions due to alcohol differed to admissions not due to alcohol being on average younger (45 vs 56 years, p<0.001) more often male (73.4% vs 45.1% males, p<0.001) and more likely to have a diagnosis synonymous with alcohol or related to recreational drug use, pancreatitis, deliberate self-harm, head injury, gastritis, suicidal ideation, upper gastrointestinal bleeds or seizures (p<0.001). An increase in admissions due to alcohol on Saturdays reflects a surge in admissions with acute alcohol intoxication above the weekly average (p=0.003).

Conclusions: Alcohol was thought to be implicated in 21% of emergency admissions in this cohort. CAD is responsible for a significantly greater proportion of admissions due to alcohol than acute intoxication. Interventions designed to reduce alcohol-related admissions must incorporate measures to tackle CAD.

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Influence of alcohol and other substances of abuse at the time of injury among patients in a Norwegian emergency department

Bakke, E. et al. BMC Emergency Medicine. Published online: 8 June 2016

5393-2Background: The presence of alcohol or other substances of abuse in blood or urine from injured patients is often used as a proxy for substance influence at the time of injury. The aim of this study was to obtain an estimate of substance influence at the time of injury based on blood concentrations of alcohol and other substances of abuse, and to explore the relationship between the substance prevalence at the time of admittance to the hospital and the actual influence at the time of the injury.

Methods: The study included all adult patients admitted to the emergency department of a university hospital during 1 year (n = 996). Quantification in blood was done by an enzymatic method for alcohol, and by liquid chromatography-mass spectrometry or gas chromatography-mass spectrometry for 28 other substances of abuse. Concentrations of alcohol and other substances in blood at the time of injury were calculated. The degree of influence was assessed on the basis of the calculated blood concentrations, with a threshold of influence set at a blood alcohol concentration (BAC) of 0.05 %, or a substance concentration leading to an influence similar to that of a BAC of 0.05 %.

Results: A total of 324 patients (32.5 %) were determined to be under the influence at the time of injury. In comparison, 394 patients (39.6 %) had one or more substances above the cut-off limit in blood at the time of admittance to the hospital. Alcohol was the most prevalent substance causing influence at 25.9 %. Among patients with violence-related injuries, almost 75 % were under the influence of alcohol and/or substances. Patients under the influence were younger, and men were more often under the influence than women. More patients were under the influence at nighttime and during weekends than at daytime and on weekdays.

Conclusions: About one third of the injured patients were determined to be under the influence at the time of injury, with alcohol being the most prevalent substance causing influence. Approximately 98 % of the patients with alcohol detected in blood at the time of admittance to the hospital were under the influence of alcohol at the time of injury.

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