1. The “Serial Inebriate Program”

2. The Impact of Dozens of Frequent Utilizers of the EMS System and the Emergency Departments each day continues in Dallas County …and emergency and hospital resources continue to be distracted toward frequent users

3. The San Diego Effort: Dunford JV. Annals of Emergency Medicine 2006; 47:328-336 The Serial Inebriate Program

4. San Diego set up a program to identify the Individuals placing the greatest burden on the community due to unrelenting substance abuse Challenges

5. In California it is a misdemeanor to be publicly intoxicated. Using this authorization, the program brings persons charged four times in a month into the program The Authorizing Statute

6. Website: www.sandiego.gov/sip

7. Participating Agencies

8. Summary of the Problem - the impact of 529 specifically identified individuals with >5 visits/month to sobering center over 4 year period Cost Savings to San Diego

9. 409 (77%) amassed 3,318 Emergency Department visits 409 (77%) amassed 3,318 Emergency Department visits 217 (41%) required 652 hospital admissions 217 (41%) required 652 hospital admissions Resulting in 3,361 inpatient days Resulting in 3,361 inpatient days Experience from 2000 -2003 Experience from 2000 -2003 308 (58%) were transported by EMS 2,335 times 308 (58%) were transported by EMS 2,335 times Health care charges totaled $17.7 million Health care charges totaled $17.7 million Payments for only 18% of charges were received Payments for only 18% of charges were received The Cost to the Community in San Diego before the SIP

10. A subsequent study revealed a 50 percent reduction in use of emergency resources by this population through the Serial Inebriate Program Cost Savings in San Diego through the SIP

11. Current Efforts to Advance the Development of The Serial Inebriate Program in Dallas, Texas

12. Available Data sets for SIP Cross-linking  Arrests  EMS Responses and Transports  ED and Psych Visits Setting up a SIP in Dallas

13. Arrests Over A One-Year Period

14. The Continuing Burden of Services that Certain Patients Require is Enormous and Expensive This ongoing massive use of emergency services is a very real system problem

15. The Problem Patient Escalation is the rule

16. A Single Patient Presenting to Our EMS System Current EMS Responses and Transports

17. The Same Individual at One Area Hospital The # of ED Visits Sept to October 2011 For Substance Abuse Issues 14 in September 13 in October 23 ED uses at one hospital alone!!!

18. The Same Patient’s Blood Alcohol Levels (note the increasing frequency of ED visits with severe alcohol intoxication) The Same Patient’s Blood Alcohol Levels (note the increasing frequency of ED visits with severe alcohol intoxication)

19. Sample Patient’s Presenting Complaints for the last two months Sample Patient’s Presenting Complaints for the last two months

20. Estimates of Total Charges Average EMS Bill = $1,000 Average ED Bill = $2,000

21. Estimates of Total Charges 13 EMS Transports = $13,000 23 ED Uses = $26,000 Total Emergency Use = $39,000 in Two Months Alone Annual Community Burden of ~ $250,000!!!!

22. And Additional Burdens… These are EMS Responses that might have been saving a life for a member of the community The hundreds of ED beds being taken up PER YEAR amounting to thousands of hours of ED occupancy by ONE PERSON due solely to substance abuse

23. Elsewhere in Texas The San Antonio SIP Leon Evans

24. Efforts Underway in Dallas Gaining IRB approval to bring the available databases together for study Gaining IRB approval to bring the available databases together for study Identifying participating agencies Identifying participating agencies Looking for potential additional Looking for potential additional funding sources

25. Existing Resources in Dallas Dallas Police Department Dallas Police Department Crisis Intervention Team Dallas County Corrections Dallas County Corrections Judicial System Judicial System The Salvation Army The Salvation Army The Bridge The Bridge Dallas Fire/Rescue Dallas Fire/Rescue Parkland Hospital/ UT Southwestern Parkland Hospital/ UT Southwestern DCHD COPC Clinics DCHD COPC Clinics Psychiatric Units Psychiatric Units

26. The Challenge: Finding a More Definitive Intervention for the Chronic Inebriate while Protecting our Valuable but Limited Resources

27. Thank You!!

28. melanie.lippmann@utsouthwestern.edu