RADAR Rapid Access to (alcohol) Detoxification: Acute hospital Referrals

What is RADAR ? Rapid access from acute hospitals to a bespoke 5-7 day alcohol detoxification with range of evidence based psycho-social interventions. A strong focus on engagement and aftercare planning, which leads to better outcome from detoxification and reduced re-presentation to acute hospitals in the future. Evidence based symptom triggered detoxification, together with physical health management and mental health treatment as necessary with 24 hour cover. 10 bedded ward at a specialist detoxification facility, working closely with colleagues in 11 acute hospitals across Greater Manchester. A pathway for patients presenting to the hospitals with alcohol related problems who require admission

The Challenge Alcohol = Significant Burden on Health System Alcohol related diseases = 1 in 8 NHS beds 35% of A&E attendees alcohol related (between midnight and 5am – 70%) North West highest rates of alcohol related hospital admissions in England and worsening gap compared to the rest of England Many patients present repeatedly for short term admissions, addressing the acute effects of alcohol and its withdrawal, but often failing to treat the underlying cause. General hospitals have targets to reduce alcohol related admissions rate, reduced avoidable admissions and readmissions ( if within 30 days leads to loss of tariff).

The Solution: RADAR Transfer of patients presenting to acute hospital to a specialist facility who : Want to stop drinking and require a detoxification who otherwise would have been admitted to an acute bed Close working with Alcohol Nurse Specialist within Acute Hospitals Transfer as rapidly as possible Access to medically managed detoxification 24 hour per day Utilising 10 beds at Chapman Barker Unit 5-7 day admission multi-disciplinary team, 24 hour hospital at night and medical support specialist individual and group PSI therapies Emphasis on engagement in aftercare and recovery communities

Main Aims and Outcomes 1. To reduce burden on Acute Trusts in relation to alcohol related admissions 2. To improve clinical outcomes for service users 3. To provide improved experience for service users in a therapeutic setting 4. To demonstrate cost effectiveness

Admissions at 12 Months 339 Admissions Salford - 1 st Nov 2012 Wigan - 5 th Nov 2012 MRI - 21 st Dec 2012 NMGH - 17 th Jan 2013 Oldham - 25 th Jan 2013 Bury - 4 th Feb 2013 Bolton - 17 th Feb 2013 Rochdale - 13 th Mar 2013 Wythenshawe - 12 th Apr 2013 Tameside - 26 th Apr 2013 Stockport- 9 th May 2013 Trafford 4 th June 2013

Patient Profile 69% Male 47% years old (30% 50 years old) 73% Unemployed 84% Settled Accommodation/ 16% NFA 82% Not in significant relationship 46% ‘Frequent Flyers’ (3 or more presentations in preceding 6 months) 34% Open to Community Alcohol service 15% Open to mental health service 64% Not open to any services at point of referral 11% Never known to any service

Clinical Presentation Reason for Presentation to Hospital 52% Alcohol withdrawal (e.g. seizure) 26% Mental health (e.g. suicidal ideation) 13% Physical health (e.g. gastritis) 8% Fall (e.g. head injury) Department 23% Accident and Emergency 56% Clinical Decisions Unit/ MAU 21% General Ward Clinical Measures Mean AUDIT score = 36 / 40 (scores over 20 indicate dependence) Mean Units Alcohol in past week = 221

Post 12 months Extension to March st April further 12 month funding pending an economic evaluation Integrated with Chapman Barker Unit

Independent Evaluation Conducted by John Moores University to Dec 2014 Qualitative interviews with professionals and service users Economic evaluation via patient follow-up Early findings c. £2M savings based on 80% occupancy (currently 79%)