14.06.13
Patients with alcohol-related diseases ‘failed’ by hospitals
Hospitals are missing opportunities for early intervention for people with alcohol-related illness, in some cases leading to preventable deaths, the new NCEPOD report ‘Measuring the Units’ has warned.
The report analysed 467 patients, and found that the care of just 47% was ‘good’. 32 deaths may have been avoided, NCEPOD stated.
25% of patients were never seen by a gastroenterologist or hepatologist, only 23% of hospitals had a multidisciplinary alcohol care team and 76% of patients had been admitted to hospital on previous occasions.
NCEPOD recommends that all patients presenting to hospital should be screened for alcohol misuse, and all those with harmful drinking who are treated by acute services should be referred to alcohol support services.
A multidisciplinary alcohol care team should be introduced in each acute hospital and escalation of care “should be actively pursued” for patients with alcohol-related liver disease.
NCEPOD chairman, Bertie Leigh, said he was surprised to find that “such extremely ill people were admitted under doctors who claimed no specialist knowledge of their disease, and not transferred to doctors who did”.
He added: “There cannot be any other area of medicine where our hospitals would make such a candid admission. It is hard to avoid a feeling that these people are failed all the way through their care pathway, and that there were too many missed opportunities where the NHS could have intervened.”
Report co-author Dr Mark Juniper, NCEPOD clinical co-ordinator (Medicine) and
consultant physician at the Great Western Hospitals NHS Foundation Trust, said: “Many people with alcohol-related liver disease have multiple admissions with this condition. This gives clinicians an ideal opportunity to offer appropriate treatment and advice to patients to help them stop drinking and improve their future health.
“Unfortunately, this isn’t happening, and in over a third (47/138) of patients reviewed in this study, referral for support to stop drinking was not made, despite most hospitals reporting to have alcohol liaison services.
“This is partly because the services are not available at all times that they are needed. Similarly, patients were not always seen by a specialist in liver disease, and when they did this was often not for several days after admission.
“We know that abstinence works, and that when simple advice is offered to patients, one-in-eight will reduce their harmful drinking levels – that’s better than the results from ‘stop smoking’ support services.”
Dr Chris Roseveare, president of the Society for Acute Medicine (SAM) welcomed the emphasis on a multi-professional approach and said: “It is vital that all staff working in the acute medical unit are provided with the skills and resources to recognise and treat patients with alcohol-related illness.”
Sir Richard Thompson, president of the Royal College of Physicians, said: “Admissions to hospital for alcohol related liver disease and deaths are on the increase and particularly affect younger patients. This report emphasises the variation across the country in specialist care in hospital for these patients, and suggests how much needs to be done to bring hospital services up to an acceptable standard.
“Every patient should also have access to an alcohol support service. There is a feeling that these sick patients are denied active treatment in high dependency beds because they are thought to be irrecoverable. I hope that this report will stimulate trusts to appoint more gastroenterologists with an interest in diseases of the liver and seven day alcohol support nurses.”
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