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