Implementing an alcohol referral
pathway
The experience of an ambulance service
Cathryn James/ Tom Heywood
Context
• In Quarter 1 of 2013/14 YAS attended 10,178
999 calls where alcohol was suspected.
• This equates to 5.9% of all 999 calls (may be
higher).
• The ambulance costs are estimated at £231 per
patient.
• Over a third of frequent callers to YAS have
alcohol misuse issues.
Background
• This pathway promotes the ‘Make Every Contact
Count’ approach, a nationwide initiative to help
people stay healthy and reduce system-wide costs
to the NHS.
• Inappropriate frequent calls put an additional
unnecessary strain on the 999 service.
• Ambulance clinician’s role in terms of public health
are yet to be realised.
• Lack of evidence? The only ambulance trust to
have this pathway.
Aims and objectives
• The aim was to explore the ways in which an
ambulance service could improve the health of
their patients that present to the 999 service due to
alcohol misuse.
• The objective was to develop a pathway for
ambulance clinicians so they can identify alcohol
misuse and offer referral to specialist services.
NICE Guideline QS11:
Alcohol dependence and harmful alcohol use
quality standard
•
Statement 1. Health and social care staff receive alcohol
awareness training that promotes respectful, non-judgmental
care of people who misuse alcohol.
•
Statement 2. Health and social care staff opportunistically
carry out screening and brief interventions for hazardous and
harmful drinking as an integral part of practice.
•
Statement 3. People who may benefit from specialist
assessment or treatment for alcohol misuse are offered
referral to specialist alcohol services and are able to access
specialist alcohol treatment.
How does the pathway work?
• Clinicians identify a patient who may benefit by
using CAGE tool screening.
• Gain patient consent to refer (over 18 only).
• Refer 24/7 via YAS clinical hub (single point).
• Referral faxed to the appropriate provider.
Referral data
• Sheffield and Rotherham were pilot sites in October 2011
• From April 2012- October 2013 there were 120 patient
referrals, an average of 6 per month.
• Pathway implemented YAS wide from 2nd December 2013
• YAS wide up to the 17 April 2014 there has been 113 patient
referrals.
Resources
Current
• YAS management set up resource
• Additional YAS clinician time to make referral
• Additional time and resource at YAS clinical hub (single
point)
• Continued management of current pathway
Proposed
• Patient information leaflet/ advice card/ details of services
available
• Educational material and dedicated training for YAS
clinicians
Costs
• The costs to resource the pathway to date have
been incorporated within the current YAS budget.
• We are presently trying to quantify an overall cost
per referral.
• No immediate YAS benefits, however we believe
there benefits to wider NHS and social care
community.
Benefits
• Better patient experience/ care.
• Reduce overall burden to the NHS and social care
system.
• Referral can act as a gateway to manage other
issues.
• YAS does not receive immediate benefit.
Evaluation
• Patient stories
• Need for feedback on outcomes from providers!
• YAS are currently trying to quantify the impact on
frequent callers
• Research opportunities
• Invited to present a poster at the NICE shared
learning awards at the National conference in May
Patient story
A message for ambulance crews
‘Someone in my state wouldn’t often seek help
themselves or are often not in a state to do so. I
would like to give a message to all ambulance crews
to take every opportunity to try and refer patients with
alcohol problems; it might seem as if it will fall on
stony ground but on every occasion they should try
(please don’t be put off). The input from the crew
was invaluable for me and could be for others too.’
Future YAS data collection
• Extend CAGE questionnaire to ask where the
patient accessed their last drink from.
• Hot spots for alcohol related calls.
• YAS data on frequent callers.
Next steps
• Further development is underway for the pathway
to include children/ young people (NICE quality
statement 12)
• Expand pathway for substance/drug misuse
• YAS staff education/ training; opportunity to
develop Identification and brief intervention
training for YAS staff
• More robust data collection and clinical outcomes
Next steps continued..
• Move from faxed referrals to a secure electronic
process.
• Ensure a smooth handover of service providers in
next commissioning round.
• Patient leaflets/information.
• To develop identification and brief advice (IBA)
specifically for ambulance services.
Any questions?
Future working partnerships?
Contacts.
Thomas Heywood
thomas.heywood@yas.nhs.uk Tel. 07825101616
Cathryn James
cathryn.james@yas.nhs.uk Tel. 07789865053