Project

Royal Bolton Hospital collaborative care for alcohol related liver disease and harm

Description:

Since the development, at the Royal Bolton Hospital, of collaborative care for patients with alcohol-related liver disease and harm, and in particular, the recruitment of a multi-disciplinary team, which places the client at the centre of all efforts, there has been a series of improvements in service delivery and outcomes.

The key elements of the model are: Consultant Gastroenterologist and a Liaison Psychiatrist, with a special interest in substance and alcohol misuse, facilitating joint inpatient and outpatient care, alongside a Psychiatric Alcohol Liaison Nurse and a Gastroenterology-based Liver Nurse Practitioner.

This is within the context of a genuinely multidisciplinary team, which meets daily. The two nurses jointly triage all alcohol-related admissions, Monday to Friday, at 8am in the Acute Medical Receiving Unit. They provide Brief Advice and initiate care plans. Previously, many of these patients were admitted for detoxification. They are now given rapid outpatient appointments with the Community Alcohol Team.

A dedicated social worker greatly influences the length of stay and facilitates discharge to a suitable environment. Discharge and ongoing care of patients, especially those who are outside the catchment area for the hospital, may be problematic and the daily involvement of the appropriate social worker is vital. There are particular difficulties in providing care for homeless people and rough sleepers. There are increasing numbers of young men with alcohol-related dementia, including Wernicke-Korsakoff Syndrome, for whom there is a major shortage of suitable long term care.

Clinical Governance meetings discuss all deaths, lessons learnt, end-of-life care, risk management and disease coding, to provide accurate data on disease prevalence and facilitate Payment by Results. They are transparent, confidential and conducted in a no-blame culture.

The project has implemented the key recommendations, made by the Royal College of Physicians, for local care by acute hospitals receiving unselected medical admissions. These include:

  • a screening strategy for early detection of harmful/coincidental hazardous drinkers
  • early assessment of dependence severity by appropriately trained staff
  • widely available protocols for the pharmacotherapy of detoxification
  • readily available 'acute response' from liaison or specialised alcohol psychiatry services for the management of patients undergoing complicated alcohol withdrawal
  • assessment of the need for referral to ongoing support services by appropriately trained staff, with knowledge of local services
  • provision of brief interventions for coincidental hazardous drinkers
  • provision of general staff education
  • occupational policies for alcohol for all staff, for example with respect to drinking at work
  • close liaison with GP's on discharge

Project status: Ongoing

Project type: Project

Project code: 6QTM