The profile, clinical characteristics, and outcomes of alcohol- and non-alcohol-related patient presentations to Queensland emergency departments: a multi-site observational study
Julia Crilly
A B C * , Katie East D , Josea Brown A , Ping Zhang C , Josh Byrnes E , Jeremy Furyk F G , Jill Duncan H , Leonie Jones I , Nathan J. Brown H J , David Green A C , Sean Rothwell H and David Rosengren H J
A Department of Emergency Medicine, Gold Coast Hospital and Health Service, Qld, Australia.
B School of Nursing and Midwifery, Griffith University, Qld, Australia.
C Menzies Health Institute Queensland, Griffith University, Qld, Australia.
D Department of Emergency Medicine, Metro South Hospital and Health Service, Qld, Australia.
E Centre for Applied Health Economics, School of Medicine, Griffith University, Qld, Australia.
F Department of Emergency Medicine, University Hospital Geelong, Vic., Australia.
G Faculty of Health, Deakin University, Vic., Australia.
H Emergency and Trauma Centre, Royal Brisbane and Women’s Hospital, Qld, Australia.
I Emergency Department, Townsville University Hospital, Townsville, Qld, Australia.
J Faculty of Medicine, The University of Queensland, Qld, Australia.
Abstract
The harmful use of alcohol is a global issue. This study aimed to describe and compare the profiles, emergency department (ED) clinical characteristics, and outcomes of alcohol-related ED presentations (ARPs) and non-alcohol-related ED presentations (NARPs).
A multi-site observational study of all presentations to four EDs between 4 April 2016 and 31 August 2017, was conducted. Routinely collected ED clinical, administrative and costings data were used. Classification of ARPs were prospectively recorded by clinicians. Analysis was performed at the presentation, rather than person level. Univariate tests were undertaken to compare demographics, ED clinical characteristics and outcomes between ARPs and NARPs.
A total of 418 051 ED presentations occurred within the 17-month study period; 5% (n = 19 875) were ARPs. Presentations made by people classified as ARPs were younger, more likely to be male, present on weekends or at night, and arrive by ambulance or police compared to NARPs. Compared with NARPs, ARPs had a longer median ED length of stay of over 20 min (95% CI 18–22, median 196 min vs 177 min, P < 0.001), a 5.5% (95% CI 4.9–5.3) lower admission rate (36% vs 42%, P < 0.001), and a AUD69 (95% CI 64–75) more expensive ED episode-of-care (AUD689 vs AUD622, P < 0.001).
Clinically meaningful differences were noted between alcohol-related and non-alcohol-related ED presentations. The higher cost of care for ARPs likely reflects their longer time in the ED. The healthcare and economic implications of incidents of alcohol-related harm extend beyond the ED, with ARPs having higher rates of ambulance and police use than NARPs.
Keywords: alcohol, Australia, emergency department, health economics, observational study, outcomes, prehospital, service delivery.
References
2 World Health Organization [WHO]. Global status report on alcohol and health 2018. Geneva: World Health Organization; 2018. Available at https://ncdalliance.org/sites/default/files/resource_files/9789241565639-eng.pdf [verified 22 April 2022].
3 Egerton-Warburton D, Gosbell A, Wadsworth A, Fatovich DM, Richardson DB. Survey of alcohol-related presentations to Australasian emergency departments. Med J Aust 2014; 201: 584-587.
| Crossref | Google Scholar |
5 Australasian College for Emergency Medicine. Alcohol and Methamphetamine Harm in Emergency Departments: findings from the 2019 Snapshot Survey. Melbourne: ACEM; 2020. Available at https://acem.org.au/getmedia/f7bec2c4-6573-471f-8cf4-f9a0bc466506/Alcohol-Snapshot-Report_R6 [verified 31 August 2022].
6 Kisely SR, Pais J, White A, Connor J, Quek L-H, Crilly JL, Lawrence D. Effect of the increase in ‘alcopops’ tax on alcohol-related harms in young people: a controlled interrupted time series. Med J Aust 2011; 195: 690-693.
| Crossref | Google Scholar |
7 Fulde GWO, Smith M, Forster SL. Presentations with alcohol-related serious injury to a major Sydney trauma hospital after 2014 changes to liquor laws. Med J Aust 2015; 203(9): 366.
| Crossref | Google Scholar |
8 Bakke E, Bogstrand ST, Normann PT, Ekeberg Ø, Bachs L. Influence of alcohol and other substances of abuse at the time of injury among patients in a Norwegian emergency department. BMC Emerg Med 2016; 16(1): 20.
| Crossref | Google Scholar |
9 Mclay SVB, Macdonald E, Fatovich DM. Alcohol-related presentations to the Royal Perth Hospital Emergency Department: a prospective study. Emerg Med Australas 2017; 29(5): 531-538.
| Crossref | Google Scholar |
10 Parkinson K, Newbury-Birch D, Phillipson A, Hindmarch P, Kaner E, Stamp E, Vale L, Wright J, Connolly J. Prevalence of alcohol related attendance at an inner city emergency department and its impact: a dual prospective and retrospective cohort study. Emerg Med J 2016; 33: 187-193.
| Crossref | Google Scholar |
11 Verelst S, Moonen P-J, Desruelles D, Gillet J-B. Emergency department visits due to alcohol intoxication: characteristics of patients and impact on the emergency room. Alcohol Alcohol 2012; 47: 433-438.
| Crossref | Google Scholar |
12 Australian Institute of Health and Welfare. My Hospitals: compare hospitals. 2018. Available at https://www.aihw.gov.au/reports-data/myhospitals/my-local-area/hospitals [verified 22 April 2022].
13 Australasian College for Emergency Medicine (ACEM). G24 - Guidelines on the implementation of the Australasian Triage Scale in emergency departments. 2016. Available at https://acem.org.au/getmedia/51dc74f7-9ff0-42ce-872a-0437f3db640a/G24_04_Guidelines_on_Implementation_of_ATS_Jul-16.aspx [verified 22 April 2022].
14 Independent Hospital Pricing Authority (IHPA). Australian Hospital Patient Costing Standards Version 4.0. 2018. Available at https://www.ihpa.gov.au/ahpcs [verified 22 April 2022].
15 World Health Organization [WHO]. International Statistical Classification of Diseases and Related Health Problems – 10th Revision. ICD-10 Version: 2016. 2016. Available at http://apps.who.int/classifications/icd10/browse/2016/en [verified 22 April 2022].
16 Council of Australian Governments. The National Health Reform Agreement - National Partnership Agreement. 2011. Available at https://federalfinancialrelations.gov.au/sites/federalfinancialrelations.gov.au/files/2021-01/nhra_np_improving_public_hospital_services.pdf [verified 22 April 2022].
17 Nagree Y, Darwent B. Characterising the number and type of presentations to a tertiary emergency department by young people affected by drugs and alcohol. Aust Health Rev 2020; 44: 637-641.
| Crossref | Google Scholar |
18 Lingamanaicker K, Geelhoed E, Fatovich DM, , on behalf of the AHED Investigators.. Direct cost of alcohol-related presentations to Royal Perth Hospital emergency department. Emerg Med Australas 2019; 31(6): 1045-1052.
| Crossref | Google Scholar |
19 McNicholl B, Goggin D, O’ Donovan D. Alcohol-related presentations to emergency departments in Ireland: a descriptive prevalence study. BMJ Open 2018; 8: e021932.
| Crossref | Google Scholar |
20 Sims S, Preen D, Pereira G, Fatovich D, Livingston M, O’Donnell M. Alcohol-related harm in emergency departments: linking to subsequent hospitalizations to quantify under-reporting of presentations. Addiction 2020; 116: 1371-1380.
| Crossref | Google Scholar |
21 Zhang J, Qian S, Su G, Deng C, Reid D, Curtis K, Sinclair B, Yu P. Emergency department presentations of patients with alcohol use disorders in an Australian regional health district. Subst Abus 2022; 43(1): 1128-1140.
| Crossref | Google Scholar |
22 AIHW. Emergency Department Care Activity. 2019. Available at https://www.aihw.gov.au/reports-data/myhospitals/intersection/activity/ed [verified 2 February 2022].
23 Klein LR, Driver BE, Miner JR, Martel ML, Cole JB. Emergency department length of stay for ethanol intoxication encounters. Am J Emerg Med 2018; 36: 1209-1214.
| Crossref | Google Scholar |
24 Queensland Government. Liquor and other Legislation Amendment Bill 2017: Explanatory Notes. 2017. Available at https://cabinet.qld.gov.au/documents/2017/Feb/Liquorleg/Attachments/ExNotes.PDF [verified 31 August 2022].
25 Commonwealth of Australia, Department of Health. National Alcohol Strategy 2019-2026. 2019. Available at https://www.health.gov.au/sites/default/files/documents/2020/01/national-alcohol-strategy-2019-2028.pdf [verified 31 August 2022].
26 Australasian College for Emergency Medicine. ACEM statements on alcohol and other drug harm. Melbourne: ACEM; 2020. Available at https://acem.org.au/Content-Sources/Advancing-Emergency-Medicine/Better-Outcomes-for-Patients/Reducing-Alcohol-and-Drug-Harm-in-the-ED/ACEM-Statements-on-Alcohol-and-Other-Drug-Harm [verified 31 August 2022].
27 Egerton-Warburton D, Gosbell A, Wadsworth A, Moore K, Richardson DB, Fatovich DM. Perceptions of Australasian emergency department staff of the impact of alcohol-related presentations. Med J Aust 2016; 204(4): 155.
| Crossref | Google Scholar |
28 Butler K, Reeve R, Viney R, Burns L. Estimating prevalence of drug and alcohol presentations to hospital emergency departments in NSW, Australia: impact of hospital consultation liaison services. Public Health Res Pract 2016; 26(4): e2641642.
| Crossref | Google Scholar |
29 D’Onofrio G, Degutis LC. Preventive care in the emergency department: screening and brief intervention for alcohol problems in the emergency department: a systematic review. Acad Emerg Med 2002; 9(6): 627-638.
| Crossref | Google Scholar |
30 Hawk K, D’Onofrio G. Emergency department screening and interventions for substance use disorders. Addict Sci Clin Pract 2018; 13: 18.
| Crossref | Google Scholar |
31 Barbosa C, McKnight-Eily LR, Grosse SD, Bray J. Alcohol screening and brief intervention in emergency departments: review of the impact on healthcare costs and utilization. J Subst Abuse Treat 2020; 117: 108096.
| Crossref | Google Scholar |
32 Smalley CM, Malone DA, Meldon SW, Borden BL, Simon EL, Muir MR, Fertel BS. The impact of COVID-19 on suicidal ideation and alcohol presentations to emergency departments in a large healthcare system. Am J Emerg Med 2021; 41: 237-238.
| Crossref | Google Scholar |
33 Myran DT, Cantor N, Pugliese M, Hayes T, Talarico R, Kurdyak P, Qureshi D, Tanuseputro P. Sociodemographic changes in emergency department visits due to alcohol during COVID-19. Drug Alcohol Depend 2021; 226: 108877.
| Crossref | Google Scholar |
