Case Study

Tameside Hospital Alcohol Liaison Service (HALS) was launched in April 2013. Tameside is in the top ten nationally for alcohol-related harm in relation to health and alcohol-related harm has implications for the provision of services for our hospital.

The purpose of the team is to make sure that there are safe pathways for patients with alcohol addiction and reduce attendance to the Emergency Department with alcohol-related conditions, as well as a reducing the length of stay in hospital. The aim of the HALS team is to ensure patients are cared for and supported to understand the effects of alcohol addiction and ensure a plan of care supports their recovery.

The HALS team is made up of 3 enthusiastic Specialist nurses, 1 forward thinking Consultant and an administrative assistant, all with the determination to make a real difference to patients lives.

Alcohol harm in Tameside and Glossop is extensive and Tameside is in the top ten nationally for alcohol-related harm in relation to health. Approximately 22% of the population over 16 are binge drinkers, equating to approximately 37,000 people.

Alcohol can impact positively on the lives of adults when enjoyed moderately. However, the ambition of the service is to reshape the approach to alcohol, with the following key aims:

• Change behaviour so that it is no longer acceptable to drink in ways that cause harm to self or others
• Reduce the amount of alcohol-fuelled violent crime
• Reduce the number of adults drinking above the NHS guidelines
• Reduce the number of people binge drinking
• Reduce the number of alcohol related deaths
• Ensure patients at risk have access to the appropriate services

The team recognised the need to address the issues and identified that by developing and implementing safe pathways for patients with alcohol addiction, the impact would be to reduce attendance to the Emergency department with alcohol-related conditions, as well as a reducing the length of stay in hospital.

Staff motivation and dedication is key to developing and delivering an effective solution to the problem. As mentioned earlier the team is made up of 3 enthusiastic Specialist nurses, 1 forward thinking Consultant and an administrative assistant, all with the determination to make a real difference to patients lives. Patients are treated using an individual approach working in partnership to support their long-term recovery.

The team have developed an assessment tool and trained and motivated staff to assess all patients admitted through the Emergency Department. The team play an integral role in identifying patients presenting to the Trust with alcohol-related harm, in addition to initiating, facilitating and evaluating safe clinical treatment pathways. They then carry out an appropriate assessment; prescribe the right medication to aid recovery and ultimately aim for a positive outcome in respect of mortality and eventual addiction recovery. The patient is at the centre of their care with discussion and choices being offered along the pathway.

The launch of this service has involved ALL clinical staff groups, through a comprehensive multi-disciplinary staff education programme in addition to a bespoke training scheme.

During the first year, the HALS team have seen 1130 patients which has resulted in a reduction in attendance to the Emergency Department for this group of patients. Of the 1130 patients, 184 of these accounted for 766 attendances during 2012.

HALS have successfully reduced the Length of Stay (LOS) for each patient number of bed days by 3.4 days a 72% reduction by standardising the prescribing regime and have reduced the number of repeat attendances by 71.3% following the implementation of the monthly meetings.

The HALS team have demonstrated that by providing a comprehensive service that is patient focussed and with the right professionals involved, there is a measurable impact upon the health economy. The approach adopted has encouraged patients to become involved in developing the services and sharing their experiences has a positive impact upon how staff are trained.

In addition to providing staff training, by using the strengths of patients who have experienced the service, encouraging them to share their narrative has a wider impact upon patients who may be experiencing a similar set of circumstances.

Patient Experience is measured using a patient experience questionnaire with 100% of the responses providing positive feedback about the service.

We have learnt that a comprehensive service redesign can be achieved through partnership working and that sustainability is reliant on professional engagement at every level. Sharing performance Data and patient experience are key components to this process.

The message to others is to ensure that in establishing a new service, this should be done with complete staff engagement, in respect to understanding the direct effect of service change on creating a positive pathway for patients (with sustained positive clinical outcomes).

Both the frontline workforce and the wider multi-disciplinary team are key in delivering such changes, therefore it is imperative that they are all fully engaged in the process.