Emergency care requirements in alcohol-related presentations: a multi-site observational study
Josea Arneli Polong Brown A , Katie East B , Ping Zhang C , Josh Byrnes D , Jill Duncan E F , Leonie Jones G , Nathan J. Brown H I , David Rosengren J K , Jeremy Furyk L M , David Green N , Sean Rothwell O and Julia Crilly
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Abstract
Globally, the social and economic costs of alcohol-related disorders are considerable. The aim of this study was to determine the characteristics, clinical care requirements and outcomes of alcohol-related presentations (ARPs) to emergency departments (EDs).
A multi-site observational study was undertaken in Queensland, Australia. We selected a random sample of 2720 presentations to four public hospital EDs between April 2016 and August 2017, in which the treating clinician perceived that alcohol contributed to the presentation. Routinely collected demographic, clinical, outcomes and costings data were analysed. Additional data about clinical care delivery in the ED (bedside tests, radiology, pathology and referrals) were extracted by manual medical record review.
The ARPs predominantly involved young men: 62% arrived by ambulance and 61% arrived between 6 pm and 6 am. Most (>83%) ARPs had at least one vital observation (i.e. heart rate, blood pressure, respiratory rate) recorded, 46% had pathology, and 41% had radiology. Some form of medication (e.g. paracetamol, diazepam, thiamine) was ordered in 65% of ARPs and 20% involved intravenous fluid treatment. Referrals to a specialist team (e.g. mental health, alcohol and other drug services) were documented for 42% of patients. The median ED length of stay was 194 min (IQR: 122–292 min); the admission rate was 38%; and the median cost of ED episodes of care (in Australian dollars) was A$651 (IQR: A$422–961).
The ED resource utilisation and costs due to the use of alcohol are considerable. Public health measures that reduce alcohol-related harm have the potential to reduce ED occupancy, workloads and costs.
Keywords: alcohol drinking, clinical care, costs and cost analysis, emergency department, emergency medicine, health resources, hospital, observational study, vital signs.
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