Integrating alcohol screening and intervention in an inner-city accident & emergency department – from theory to practice

The alcohol harm reduction strategy for England and subsequent White Paper highlight the problems associated with excessive alcohol consumption, and emphasise the role that A&E should play in the identification and management of such patients. Kings College Hospital is a busy inner-city A&E with a turnover of 105,000 patients per year. Based on the data from the alcohol strategy, at least 40,000 of these patients are hazardous drinkers and would benefit from some intervention to reduce their alcohol consumption. Following the example of good practice set at St Mary’s Hospital, Paddington described by Crawford et al (Lancet, 2004), we have started to implement an alcohol screening policy in our department. In a department that has no previous history of targeting alcohol related presentations, we wanted to explore how best to introduce such a policy. Our aim is to develop a set of guidelines that will inform other departments seeking to introduce such policies themselves. Data on screening has been collected using the A&E computer system and the impact of teaching sessions for clinical staff (Drs and Nurse Practitioners) as well as the introduction of a paper-based system has been assessed. Interviews with clinical staff illustrate the barriers and facilitators to implementing this policy. Additionally our substantive baseline data also allow for a rapid review of the impact of changes to licensing hours on alcohol related attendances