Counting Drunks

From TheyWorkForYou.

Sandra Gidley (Romsey, Liberal Democrat)

“To ask the Secretary of State for Health how many (a) male and (b) female teenagers were admitted to accident and emergency departments on grounds related to drunkenness in each month of (i) 2007 and (ii) the last five years, broken down by NHS trust; and what treatments they required, broken down by category.”

Dawn Primarolo (Minister of State (Public Health), Department of Health)

“We do not collect data relating to alcohol-related attendances at accident and emergency departments.” [Emphasis mine]

Tables have been placed in the Library which supply data for teenagers admitted to hospital [Emphasis mine] via accident and emergency with a primary diagnosis of T51 toxic effect of alcohol (i.e. more severe than general drunkenness and loss of inhibitions) for the last five years, broken down by gender and health care provider. The information provided in the tables does not include instances of the toxic effects of alcohol as secondary diagnosis.”

From the BBC

The introduction of 24-hour drinking laws may have trebled alcohol-related admissions to A&E departments in inner city areas at night, a study claims.

Researchers at London's St Thomas' Hospital compared overnight visits before and after the 2005 law change.

There were 80 alcohol-related visits in March 2005. This hit 250 in 2006, the Emergency Medicine Journal said. “

We 'code out' all our calls. There are two or three numbers to write down that represent what has happened to our patient. The first number is the 'type of injury' code. So (from memory) – Code 01 is 'Illness known', 02 is 'illness unknown', 03 is 'fall', 14 is 'assault' and so on.

Then comes the injury code. 01 is 'abdominal pain', 75 is 'minor head injury', 69 is 'vomiting', 23 is 'epileptic seizure'.

'62' is alcohol related.

The small problem is that where someone has two types of injury, for example they had a seizure due to alcoholism and cracked their head open, there are only two boxes to write numbers. For the fitting head injury mentioned that would be as 57/75 ('fitting – other cause', 'head injury – minor'). There would be no place to write down the '62' – alcohol related.

Couple that with the problem that the boxes are very small and easily forgotten and are therefore are occasionally not filled in and you have an obvious lack of data on how alcohol affects A&E attendance.

There are some vague figures mentioned in parliament. But these are only for people admitted to hospital – not for that much more common breed of people who are treated and discharged or are allowed to sober up and make their own way home. Or for those that attend, are violent and are thrown out.

So the St Thomas' Hospital study is incredibly important, and should be going on nationwide. During nightshifts alcohol probably accounts for 40-60% of my work, half that during dayshifts. Yet it would seem that no-one is recording or studying the numbers and types of people using the NHS for this reason.

Again from the BBC

“Both the Department of Health and the Department of Culture, Media and Sport, which was behind the legislation [to increase licensing hours], were dismissive of the findings, noting that the study only related to one hospital in one particular month.”

So why isn't there a more widespread counting of the number of alcohol related attendance? Something done all year in all hospitals, something involving ambulance service trusts. Just a simple tickbox asking if we considered alcohol the cause of the injury or illness.

If it were recorded and studied, might it not make a difference in how we provision care, fund hospitals, amend licensing laws and tax alcohol?

Or is that why it's not done?

27 thoughts on “Counting Drunks”

  1. The thing is – we have a box for 'Forced entry required Y/N' which we never use (because if we force an entry I'll document fully why I did it, not tick a box), so a similar tick box of 'Alcohol related Y/N' wouldn't be a hardship.And the compilation of the data would be automatic as the report forms are scanned by computer. So no extra money needed.

    Simple really – it just needs the will to be implemented.

  2. With all the stats and coding that is already done it shouldn't be difficult to pull this information together. Plus it's not really research, I'd call it clinical audit. One thing that the electronic patient record (if it ever works) would be great for is doing this kind of study quickly and watching for any trends in diseases etc.

  3. I think you might have answered your own question there Tom.I expect nearly every medical worker out there knew this legislation would result in a bigger workload on the NHS, how giving people more access to alcohol is meant to reduce consumption is beyond me.

    This study, even if it isnt done across the whole country, needs to be done on a much wider scale. Perhaps someone should start some sort of petition somewhere?

  4. Not so sure the information is there to pull together (NHS data and information sharing doesn't always work as smoothly as you might think it should). And even if it was there you still need analysts & statisticians to do the work, and that requires funding – and there's the crux of the matter – while stats and info would be useful the money to produce them needs to come from somewhere and that means less money somewhere else in the NHS – cue complaints about money being wasted on more administration and being removed from the front-line staff, and shouldn't we just be paying for more nurses/paramedics etc….

  5. Essex ambos have drug suspected or alcohol suspected boxes to complete on there Patient forms. I'm sure if someone stumbled upon the cash to look into it there would be a significant rise in alcohol suspected cases, but as said already, not rocket science.

  6. It's also explicitly stated in the parlimentary answers that this data isn't recorded – only those that are *admitted* with a diagnosis of *Alcohol overdose*.What is not apparently counted is the much more frequent 'pissed and fell over', 'pissed and fell asleep in the street', 'pissed and fighting', 'pissed and self harming', 'pissed and vomiting', 'pissed and 'unconscious''.


  7. Might be worth someone in Essex posting a Freedom of information request to Essex Ambulance to see what percentage of completed PRFs have those boxes ticked.

  8. That is radiculous the amount of people who use an amblance each year through drinking to much. You would think that if they where old enough to be allowed to drink they would be old enough to know when to stop. I personally don't have much problem with people heving a bit to much to drink every now and then but if you are going to you should organise someone to take you home. This way they can vomit to their hearts content and at the same time paramedics and hospital staff can spend their time dealling with people who are actually sick. If a 13 year old can understand that then it shouldn't be to difficult for an 18 year old to !!!!!

  9. Lies, damned lies and statistics. In our spreadsheet driven working culture that is all that counts. However, what is counted is not always in the results. A mirror is held up to life and all the bits that don't fit are cut off.Modern Managers are taught the art of concocting these reports so as not to annoy their political masters. Such are the joys of working in the public sector.



  10. I'm Irish. Well used to this binge-drinking culture that pervades the UK too. I've drunk way too much since I could pass for 18 at the off-license. I've also spent 1/3 of my life in other European cultures, where pubs are open longer, and people get just as pissed, but don't have such a violent reaction to getting drunk.My question is this: Is it a cultural thing, do you think? I'm all for longer pub-opening hours, as well as more liberal laws regarding drugs, but I know that my reaction to being pissed isn't rampant testosterone-fueled-limit-testing.

    So what is the cause of the violence? That's what I'd like to see addressed, and I don't think that it's alcohol. Most of the football violence wasn't alcohol fueled. It was pre-meditated and seemed to be latent anger and boredom channeled into kicks and punches.

    For me, blaming alcohol isn't right. Perhaps it's a mitigating catalyst, but it's not the source of the latent violence.

  11. As a paediatric nurse in our local A&E i am carrying out an audit on all kids attendances 0-18, the amount of drunk kids we get in from 13-18 is very high and prob counts for 25% of our attendances, particularly this time of year!! Either they have collapsed through excessive amounts or get in to fights, or just distressed.

  12. Cheers Tom. I was shouting at the telly when they announced this. In Kent we too have an alcohol related box, but having just had a collision…….sorry, merger with Surrey and Sussex, any attempt to get anything sensible out of the new trust is likely to be wholly unsuccessful.

  13. I don't think the violence etc is alcohol induced either. I think that as a nation there is a general level of apathy and boredom and low expectation which leads to aggression and alcohol amplifies this but does not CAUSE it.Also I think that looking at a hospital like St Thomas's isn't necessarily representative of the whole country. Think I can say that as I've experience of lots of hospitals round the UK and elsewhere, and I also worked at St Thomas's!

  14. Please Tom, what do you think? I know (read) you having to deal with it all, but you were also on the front with football violence, and I know you are a thinking person. Is it really a problem with alcohol? I don't think so. Let's discuss this. I want a solution/understanding as much as anyone. For me drinking is a pleasurable activity, like sunbathing in the park. I don't want to involve any medical staff in my fun…, and I'm sure that were the readers (and writer) of this blog to go out and consume an inconsiderate quantity of alcohol, that we wouldn't have any ER problems…

  15. So how do you code a drunk who gets home, falls from his first floor window into a rose bush, then gets bitten by a dog, runs away into a lamppost, which has been vandalised, whereupon he gets a severe electric shock which throws him into the road and a car hits him?

  16. Nah. A casualty scriptwriter would have a helicopter then drop on him with such force it pushes him through the ground onto an underground train (which happens to be the Circle Line). There would be a story revolving around all the services trying to find him before he falls off. Being the Circle Line would have kept the story going till midnight.

  17. Allof the A&E departments I've ever been in are very strict about 'coding'- you have to tick boxes, or write code numbers, for diagnosis, investigations and treatment. This is how they get paid by the Primary Care Trusts. There is always a box for alcohol related, so why the governmental lies? This data IS being collected, on a daily basis.

  18. collected locally does not meant that the government / parliament has access to collated national figures – it's one thing collecting it and another collating it on a national level

  19. We have 3 boxes on our patient report forms for ” condition codes “.. unfortunately the Trust haven't issued any replacement sheets of these codes for about 4 years, so unless you have the memory of an elephant, it's unlikely you'll put them in the box.. They also want to collect ethnicity data.. same problem..!All I know is I'm constantly replenishing the cardboard hats on the vehicle… much more than before..

  20. you'd either moan about having another form to fill in or ask why the wages of the poor sod whose job it was to do it or to compile that figure from existing data weren't being spent on ambulance men.

  21. No, no, it's not silly at all, keep going… *scribbles notes frantically* – I can get a book outta this, I'm sure. ;)Besides, it's still not as silly as some of the actual Darwin Awards!

  22. in our new 'merged' ambulance service we also like Essex have an Alcohol related and Drug related tick box!Surely it dosen't take a rocket scientist to figure out (More Alcohol Available + More Time Available) + Drunk Idiots = More cost and time to A&E!

  23. As has been mentioned in other posts,here in the midlands we also have an Alcohol and Drug related tick box on our PRF,s so the information is out there for the DoH to collate and research.But in my experience having dealt with the DoH on many occasions it most certainly is a case of “If you dont like the truth dont go looking for it” but hey what do i know i aint been to medical school

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