Hospitals miss chances to cut deaths from alcohol related liver disease, report saysBMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f3781 (Published 13 June 2013) Cite this as: BMJ 2013;346:f3781
All rapid responses
I agree with the author that general hospitals, at present, do not take advantage of the many opportunities to rapidly assess patients’ alcohol consumption and thus do indeed miss a chance to identify hazardous and harmful levels of consumption and offer help or advice as needed.
In a national survey of Emergency Department alcohol screening and intervention (SBI) we undertook in 2007, we noted the missed opportunities and suggested that integration of SBI into routine practice would help to reduce the burden of alcohol misuse (1). Since then a revised alcohol strategy and several sets of NICE guidelines have also promoted the uptake of SBI in the ED, and our subsequent 2012 survey (2) revealed signs of improvement, with a dramatic increase in the proportion of departments undertaking formal alcohol screening and offering access to interventions.
I suggest that the lessons learnt in the Emergency Department on both the mechanisms of identification and intervention, but perhaps more importantly upon the integration and implementation of changes to routine practice could be applied to the wider general hospital setting. It is not hard to envisage a time when asking questions about alcohol consumption has become as commonplace as those regarding smoking, diet and exercise. While those opposed to widespread adoption of SBI may argue that it leads to an increase in workload, it should be remembered that the recent SIPS trailblazer project (3) recommend the Single Alcohol Screening Question, and demonstrate that significant reductions in alcohol consumption and harm can be achieved with the provision of simple advice or a leaflet.
(1) Patton R, Strang J, Birtles C & Crawford MJ, 2007, Alcohol: a missed opportunity. Results of a survey of all AEDs in England. Emergency Medical Journal, 24; 529-531
(2) Patton R & O’Hara P, 2013, Alcohol: signs of improvement. The 2nd National Emergency Department survey of Alcohol Identification and Intervention activity. Emergency Medical Journal, 30:492–495. doi:10.1136/emermed-2012-201527
(3) Kaner E, Bland M, Cassidy P, Coulton S,et al, 2013, Effectiveness of screening and brief alcohol intervention in primary care (SIPS trial): pragmatic cluster randomised controlled trial. BMJ 01/2013; 346:e8501.
Competing interests: No competing interests