Sandwell and West Birmingham Hospital - alcohol care team

Background and aims

Sandwell and West Birmingham Hospital (SWBH) NHS Trust serves more than 530,000 local people from across the North-West Birmingham. It provides integrated care to improve the lives of the local people and their vision strives on encouraging healthy lifestyle choices and offering more accessible outpatient clinics in community centres and GP practices.

SWBH have high levels of deprivation and unemployment and within the low-income areas, with alcohol being a major cause of harm within these communities. This meant that many people were presenting to the emergency department with alcohol dependency. As a result, there was a high number of avoidable admissions and re-admissions into SWBH emergency departments.

SWBH commissioned alcohol care teams (ACTs) within their acute hospitals to provide specialist alcohol care for patients with alcohol dependence. It was hoped that the ACTs would prevent unnecessary admissions into hospital, improve the management of acute alcohol withdrawal, improve education for staff and enable psycho-social interventions to be rolled out to patients.

Solution

The SWBH Trust alcohol care team was introduced to two of their sites which runs seven days a week, which offer pathways to support admissions to emergency departments and support guidance for symptom-triggered withdrawal in patients. The ACTs included a multidisciplinary team involving a consultant lead, alcohol specialist nurses, alcohol nurses and speciality alcohol practitioners and a full time administrator.

Patients attending the emergency department with alcohol dependence were referred to the ACT for assessment. Those with acute medical concerns were admitted and supported by the ACT, whereas those with acute withdrawal only were discharged and offered to be assessed the following day.

Following initial comprehensive assessment, the ACT would propose a management plan best suited to the client’s individual needs. This might involve referral to community services, continuing to work with the ACT, or a combination of both services.

The ACT offered guidance on safe reduction of drinking to a point of abstinence, elective detoxification, offered relapse prevention advice together with psychosocial support for both patients and carers. Additionally, the ACT offers fortnightly meetings for friends and families, AA meetings at the hospital and access to online AA meetings from the hospital bed.

Outcomes

In its first year, the ACT focused on improving the management of alcohol withdrawal and the care of patients with alcohol misuse issues. Outcomes included:

• The ACTs original target was to see 1,800 new referrals per year. In its first year, the service saw 2,156 new patients
• The average length of stay for alcohol-related admissions reduced from the baseline of 3.2 days to 2.5 days.
• 700 bed days were prevented, resulting in a financial saving of £300,000.
• 100% of patients presenting to emergency departments were seen within the hour.
• 48 staff per month received tuition from alcohol teams (with monthly targets aiming for 30).
• Large improvements were seen in patients reporting positive experiences of their care.

In the past four years, the ACT have:

• Prevented 1,950 bed days 
• Reduced the number of admissions for acute withdrawl from 1.66% to 0.68%.

“I would highly recommend this service to anyone with similar issues. Everyone without exception was amazing and went above and beyond the call of duty.” 

Service user of the SWBH alcohol care team.

Additional outcomes include:

• The ACT won the emergency and critical care category at the 2022 nursing times awards.
• The ACT won the 2020 vision prize for integrated care pioneer of the year at the 2019 SWBH star awards.
• The ACT were highly commended in the national HSJ awards in 2021.

Additional information

You can find out more about SWBH alcohol care team by accessing the NHS Long Term Plan Case Study