PERCEPTIONS OF ALCOHOL-RELATED ATTENDANCES IN ACCIDENT AND EMERGENCY DEPARTMENTS IN ENGLAND: A NATIONAL SURVEY

Alcohol & Alcoholism Vol. 33, No. 4, pp. 354-361, 1998 PERCEPTIONS OF ALCOHOL-RELATED ATTENDANCES IN ACCIDENT AND EMERGENCY DEPARTMENTS IN ENGLAND: A NATIONAL SURVEY S. WALLER*, B. THOM 1 , S. HARRIS and M. KELLY Health Education Authority, Trevelyan House, 30 Great Peter Street, London SW1P 2HW and 'Centre for Research on Drugs and Health Behaviour, Imperial College School of Medicine, 200 Seagrave Road, London SW6 IRQ, UK (Received 24 September 1997; in revised form 14 January 1998; accepted 22 January 1998) Abstract — The results from a survey, conducted in February and March 1997, of all Accident and Emergency (A&E) departments in England are presented. The survey examined staff perceptions of the preventive role of A&E departments in screening and intervention in alcohol-related attendances. Perceptions of the prevalence of alcohol-related attendances were also included. Attitudes towards developing a preventive response were positive. Few departments currently screen or offer intervention and considerable barriers to the implementation of a preventive response were reported. INTRODUCTION Alcohol is an important factor in attendances at Accident and Emergency (A&E) departments (Cherpitel, 1993; Smith et al., 1996). In England, it has been estimated that there are ~ 10 000 attenders with alcohol-related problems each year (Green et al., 1993). However, the potential for effective intervention in A&E departments is not clear. Brief interventions for alcohol problems have consistently been found to be effective in reducing alcohol consumption of ~25—30% in excessive drinkers (Richmond and Anderson, 1994), in general practice and hospital wards/clinics (Orford and Edwards, 1977; Chick et al., 1985; Wallace et al., 1988; Bien et al., 1993). However, Heather (1995) emphasized that a distinction should be made between brief interventions among treatment seekers and the non-treatment seeking populations. He pointed out that evidence for the effectiveness of opportunistic interventions is much stronger than for brief interventions in specialist settings for those seeking help. Such interventions also tend to be shorter, less structured, less theoretically based and cheaper than those offered to patients attending specialist clinics. *Author to whom correspondence should be addressed. Attention has been drawn to the nurse's role in the identification of, and response to, alcoholrelated accidents and injuries (Keech, 1992; Roberts, 1996) and Smith et al. (1996) have assessed the provision of a specialist alcohol nurse in the A&E department as an effective response to alcohol-dependent patients. But, currently, we know little about existing responses in England or about the willingness of A&E staff to expand their role in the management of patients with alcohol-related attendances. This paper reports descriptive data from a national survey of A&E departments in England conducted by the Health Education Authority. The aims of the survey were: (1) to assess the extent to which A&E departments already have policies or guidelines referring to alcohol-related attendances; (2) to investigate staff perceptions of the prevalence of alcohol-related problems and of the preventive role of A&Es; (3) to gauge the level of interest in improving preventive responses within A&E departments. 'Preventive role' of A&Es refers to the introduction of measures to detect alcohol-related attendances and reduce the likelihood of repeated admissions by the same individuals for alcohol-related problems, for instance, by reducing alcohol consumption, by encouraging less harmful drinking, or by reducing the risk of incurring the physical, psychological, and social harms associated with drinking. 354 © 1998 Medical Council on Alcoholism ALCOHOL-RELATED ATTENDANCES IN A&E DEPARTMENTS METHODS A four-page self-completion questionnaire was sent to Clinical Directors and Nurse Managers in all A&E departments in England in February 1997. This was followed up by a reminder letter 2 weeks later and 10 days later telephone interviews with non-respondents were carried out. Of a total of 228 A&E departments, four specialist emergency units were excluded from the survey as they took referrals for orthopaedic, eye and ear problems from the general A&E of the hospital; thus the total survey sample included 224 A&E departments in England. We provided an explanation of 'alcohol-related attendances' to respondents in a letter sent with the questionnaire. It stated that: 'By alcohol-related attendances, we mean all attendances relating to alcohol, including acute alcohol poisoning, alcohol withdrawal, alcohol-related accidents in the home and workplace, road traffic accidents, self-injury and assault'. The questionnaire consisted of sections enquiring about current practice, estimated prevalence of alcohol-related attendances as well as types of alcohol-related problems, perceptions of difficulties of screening and of providing advice to alcohol-dependent patients and patients who are not dependent but where alcohol consumption is a factor in the attendance. The questionnaire also included five-point rating scales (responses ranging from agree strongly to disagree strongly) including statements on the preventive role of A&Es, and statements assessing the level of interest of A&E staff in identifying and responding to alcohol-related attendances. RESULTS Response rate Replies, from a doctor, a nurse or both, were obtained from 216 A&E departments, representing 96% of the total 224 A&E departments included in the sample. The response rate was 20% after the first mailing of questionnaires, which increased to 45% following a reminder letter and to 82% following intensive telephone follow-up consisting of interviews and reminder calls. There was a higher response rate (88%) to the Nurse Manager's questionnaire compared to the Clinical Director's (76%). The high overall response rate 355 of 82% is indicative of the effectiveness of telephone follow-up. Respondents completing the Clinical Director's questionnaire were the following: 6% Clinical Directors, 69% Consultants, and 25% Junior Doctors, such as Senior House Officers (SHOs). The respondents who completed the Clinical Director's questionnaire will be referred to as 'doctors' throughout this report. The Nurse Manager's questionnaire was completed by 21% Nurse Managers, 27% Sisters/ Senior Sisters, 9% Senior Nurses, 8% Staff Nurses, 5% Charge Nurses, and 28% by nurses in other managerial or specialist functions. The respondents who completed the Nurse Manager's questionnaire will be referred to as 'nurses'. Doctors were predominantly male (85%) whilst the majority of nurses were female (78%). As we were interested in differences between doctors' and nurses' perceptions, the data were analysed separately for the two samples. Current practice Respondents were asked to report on existing procedures for identifying and responding to alcohol-related attendances. Compu (...truncated)