MORIARTY K.J. Alcohol Care Teams: to reduce acute hospital admissions and improve quality of care. Published on behalf of the British Society of

Transcription

1 MORIARTY K.J. Alcohol Care Teams: to reduce acute hospital admissions and improve quality of care. Published on behalf of the British Society of Gastroenterology Quality, Innovation, Productivity and Prevention (QIPP) Publication on NHS Evidence website ( catid=15080).

2 Evidence Summary

3 Key Recommendation (1) DGH Requirement A multidisciplinary Alcohol Care Team, led by a Consultant, with dedicated sessions, who will also collaborate with Public Health, Primary Care Trusts, patient groups and key stakeholders to develop and implement a district alcohol strategy.

4 Key Recommendation (2) DGH Requirement Coordinated policies on detection and management of alcohol-use disorders in Accident and Emergency departments and Acute Medical Units, with access to Brief Interventions and appropriate services within 24 hours of diagnosis.

5 SHORT AUDIT - C TEACHABLE MOMENT SCORE AUDIT-C positive i = 5+

6 PAY OFF For every 2 patients referred to the Alcohol Nurse Specialist (i.e. appointment accepted) There will be one less re-attendance within the next 12 months. Screening and referral for Brief Intervention Lancet 2004;364:1334-9

7 Key Recommendation (3) DGH Requirement A 7-Day Alcohol Specialist Nurse Service and Alcohol Link Workers Network, consisting of a lead healthcare professional in every clinical area.

8 JOINT GASTROENTEROLOGY/ PSYCHIATRY NURSING Weekly Clinic. Simultaneous with Doctors Open Access Phone, Secretaries, Ward Reduced Waiting Times, DNA Rates, Length of Stay Network 50+ Link HCPs Trained 600 Nurses to do SHORT AUDIT C on ALL New Inpatients If positive, Patients referred to Alcohol Specialist Nurses Education/Training/Support/Audit i i /S /A di Data for Trust and Health Commissioners District Health Promotion

9 Bolton 7-Day Alcohol Specialist Nurse Service Current ASNs 1.0 WTE Band 6 Liver Nurse = 36,000 p.a. 1.0 WTE Band 6 Psychiatry Nurse = 36,000 p.a. NICE Funding of 121,000 for 2 extra ASNs 1.0 WTE Band 7 Liver Nurse/Team Leader (+ W/E working) = 57,000 p.a. 1.0 WTE Band 5 Psychiatry Nurse (+ W/E working) = 40,000 p.a. Existing i Band 6 PLN W/E working = 24,000 p.a. Trust Funding 1.0 WTE Band 3 Clerical Support (Mon-Fri) = 21,000 p.a. 7 D ALCOHOL SPECIALIST NURSE SERVICE 7-Day ALCOHOL SPECIALIST NURSE SERVICE TOTAL COST = 214,000 p.a.

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12 Key Recommendation (4) DGH Requirement Liaison and Addiction Psychiatrists, specialising in alcohol, with specific responsibility for screening for depression and other psychiatric i disorders, d to provide an integrated acute hospital service, via membership of the Alcohol Care Team.

13 Key Recommendation (5) DGH Requirement Establishment of a hospital-led, multi-agency Assertive Outreach Alcohol Service, including an emergency physician, acute physician, psychiatric crisis team member, alcohol specialist nurse, Drug and Alcohol Action Team member, hospital/community manager and Primary Care Trust Alcohol Commissioner, with links to local authority, social services and third sector agencies and charities.

14 North West Chief Executives Challenge DGH and Locality Costs Alcohol-related Admission costs PCT 1824 Alcohol-related A&E Attendance costs PCT 80 Each avoided Admission saves Provider 300 DGH and Locality Savings 7-Day ASN Service saves 698,000 p.a. Alcohol Outreach Service for frequent flyers and > 2 AAFs/year (e.g. Liver disease) saves 895, 000 p.a. Total Locality Saving = 1.6 million p.a. Potential Saving to UK Economy = 393 million per annum

15 Key Recommendation (6) DGH Requirement Multidisciplinary, person-centred care, which is holistic, timely, non-judgmental and responsive to the needs and views of patients t and their families. MORIARTY K.J. Collaborative Liver and Psychiatry care in the Royal Bolton Hospital for people with alcohol-related disease. Frontline Gastroenterology 2011; 2:77-81.

16 1990 Established Multidisciplinary Team Weekly (1-2) Discuss Inpatients t Nurses, Doctors, Dietician, Physio, OT, Pharmacist, Chemical Pathologist, Speech Therapist, Asian Link Worker, Social Worker (Critical) Optimised, Unified Care Facilitated Discharge Planning Everyone Valued Teamworking Ethos

17 New Way of Working Bolton Gastroenterologists work 2 week blocks solely on the wards Daily Ward Rounds and MDT meeting See all Acute Gastroenterology Admissions and Ward Referrals Results Mortality 11.2% to 6.0% Length of Stay 11.5 to 8.9 days 37% Increase in Ward Discharges Downside Loss of 10 Clinic/Endoscopy Sessions in 2 weeks Conclusion This Quality Innovation requires Consultant Gastroenterology/Hepatology l Expansion

18 Key Recommendation (7) DGH Requirement Integrated Alcohol Treatment Pathways between primary and secondary care, with progressive movement ttowards management tin primary care.

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20 Summary Complex group of patients Majority admitted at least once in two years prior to final admission Care less than good in more than half of cases reviewed 20

21 Summary Missed opportunities Screening for alcohol use when patients present to hospital Referral for support Optimising fluid management Screening for sepsis Specialist review Escalation of treatment 21

22 Summary Clear opportunities to improve care: Organisation of services Alcohol care teams 7 day alcohol specialist nurse service Assessment ofpatients Screening hospital patients for alcohol misuse and referral for support Specialist review Within 24 hours for admissions with decompensated ARLD Escalation of care Actively pursued for acute deterioration 22

23 Key Recommendation (8) DGH Requirement Adequate provision of Consultants in gastroenterology and hepatology to deliver specialist care to patients with alcohol-related l l liver disease.

24 Key Recommendations (9,10,11) 9 National Indicators and Quality metrics, including alcohol-related admissions, readmissions and deaths, against which hospitals should be audited. 10 Integrated Modular Training in alcohol and addiction, available for alcohol specialist nurses and trainees in gastroenterology t and hepatology, acute medicine, accident and emergency medicine and psychiatry. 11 Targeted funding for research into detection, g g, prevention and treatment strategies and outcomes for people with alcohol-use disorders.