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AN ESTIMATED 35 PER CENT
of A&E attendances in
North West England are alcohol related. More
generally, one in eight acute hospital admissions are
due to alcohol. Manchester has one of the highest
rates of alcohol related hospital admissions in
England, significantly increasing over recent years.
Many present recurrently at A&E, resulting in multiple
short-term admissions which only address the acute
effects of alcohol, such as withdrawal symptoms, and
do not address the underlying cause.
RADAR, Rapid Access (alcohol) Detoxification Acute
Referral, is an innovative new pathway from A&E into
specialist alcohol detoxification facilities within the
Chapman Barker Unit at Prestwich Hospital.
Developed by a team within Greater Manchester West
Mental Health Foundation Trust, the pathway was
established in November 2012, and in the first year of
operation it was rolled out across 12 A&E
departments in Greater Manchester.
RADAR works closely with alcohol nurse
specialists, who identify patients presenting to A&E
with alcohol-related problems requiring detoxification,
suitable for immediate admission into the RADAR
ward. The ‘rapid’ part of the name does not just make
a memorable acronym – with the ability to accept
referrals 24 hours a day and transport available,
people can be admitted to the RADAR ward in a
matter of hours, avoiding an overnight stay in the
acute hospital.
Specifically tailored alcohol detoxification begins
immediately, taking between five to seven days before
discharge and referral to community alcohol services.
While in the RADAR ward, patients have access to a
multidisciplinary team providing 24-hour medical
support, and individual and group psychosocial
interventions. The aim of these evidenced-based
interventions, along with a strong focus on
engagement and aftercare planning, is to provide
better outcomes from detoxification and reduce re-
presentation to acute hospitals.
A team within the Centre for Public Health at
Liverpool John Moores University is working with
RADAR to explore whether the pathway is meeting its
four clearly defined aims to: reduce the burden on
acute trusts; improve clinical outcome; improve
patient experience and demonstrate cost
effectiveness.
The main reason for presentation at A&E was
withdrawal (eg seizure), with mental health issues,
including suicidal ideation, self-harm or depression,
also prominent. Many patients had three or more
admissions to A&E within the preceding six months
and a minority were in contact with a community
alcohol or mental health service.
Outcomes from RADAR are impressive. Three months
after discharge, more than half who could be contacted
reported being abstinent or being controlled drinkers.
This reduction in alcohol consumption resulted in far
fewer contacts with acute hospitals, with reductions
reported in the number of A&E attendances and nights
in hospital. Early findings from the evaluation suggest
that the pathway is cost-effective, with substantial
savings relating to reduced alcohol-related hospital
admissions following discharge from RADAR.
Dr Chris Daly, the consultant addiction psychiatrist
at the Chapman Barker Unit notes, ‘through the
development of this pathway we are seeing real
benefits in terms of improved patient outcomes and
improved experience of detoxification following an
acute presentation to A&E. One of the most
important aspects is the ownership of the pathway by
colleagues in acute trusts. In developing this pathway
we have demonstrated that we can reduce the
immediate and long-term impact of alcohol in acute
trusts and more importantly, that patients respond
positively to alcohol detoxification provided at the
moment they need it most.’
Underneath the statistics are real people with
personal accounts of their relationship with alcohol.
Many patients admitted to RADAR have chronic and
severe alcohol problems, often with other health
complications, therefore successful outcomes are not
across the board.
There have, however, been many encouraging
stories. RADAR patients interviewed were
overwhelmingly positive about their experience, in
particular about the opportunity to talk to people who
have been in the same situation. This is due to
volunteers within the unit, many of whom are ex-
patients of RADAR. Craig, an ex-patient who had more
than 140 admissions into acute care before attending
RADAR, and now volunteers in the unit, spoke of his
patient experience, saying: ‘it not only saved my life,
but gave me hope, strength and willpower to turn it
around. To be met by a caring member of the RADAR
team who knew and understood how I was feeling was
paramount to my stay and early recovery.’
The evaluation team have been struck by the
enthusiasm that patients and staff have shown for
RADAR. The main negative comments relate to issues
that are part and parcel of residential detoxification,
such as missing friends, family and pets.
What makes RADAR unique is the immediate
admission into residential detoxification straight from
A&E, when the patient needs it most. From the initial
findings of the evaluation, this appears to be one of the
more positive aspects of the pathway that could be
considered for rolling out more widely across England.
Gordon Hay is a reader at the Centre for Public
Health, Liverpool John Moores University
October 2014 |
drinkanddrugsnews
| 13
Practice exchange|
Hospital admissions
www.drinkanddrugsnews.com
Gordon Hay talks to
DDN
about RADAR,
a new pathway for
alcohol-related A&E
admissions into
residential alcohol
detoxification in
Greater Manchester.
Vital
care
Manchester has one
of the highest rates
of alcohol related
hospital admissions
in England.