调查澳大利亚教学医院中与酒精相关的就诊管理情况。
Investigating the management of alcohol-related presentations in an Australian teaching hospital.
机构信息
Centre for IT-enabled Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia.
Illawarra and Shoalhaven Local Health District, Wollongong, Australia.
出版信息
Drug Alcohol Rev. 2019 Feb;38(2):190-197. doi: 10.1111/dar.12906. Epub 2019 Feb 7.
INTRODUCTION AND AIMS
Alcohol-related morbidity is estimated to range from 10-38% of the presentations to hospital emergency departments. This study aims to investigate the actual management process for alcohol-related presentations in a teaching hospital in Australia.
DESIGN AND METHODS
Retrospective audit was conducted on the electronic medical records of 210 presentations with a primary or secondary diagnosis of 'alcohol use disorder' at discharge between November 2016 and February 2017. Six key management steps were investigated: identification of alcohol use disorder, documentation, thiamine, alcohol withdrawal assessment, benzodiazepine for alcohol withdrawal and referral to the drug and alcohol consultation liaison service.
RESULTS
Of all the 210 presentations, 77.1% (162) were identified with alcohol use disorder in the initial assessments; 64.3% (135) were documented with alcohol use history, 49.5% (104) were prescribed with thiamine, 48.1% (101) were assessed with the alcohol withdrawal scale, 41% (86) were prescribed with benzodiazepine for alcohol withdrawal and only 38.6% (81) were referred to the drug and alcohol consultation liaison service. Only 8.6% (18) of the initial presentations were directly related to alcohol. These presentations had a higher completion rate in each of the six steps than those (91.4%, 192) not directly related to alcohol. Only 6.2% (13) were formally screened for alcohol use.
DISCUSSION AND CONCLUSIONS
The findings suggest a need to improve the alcohol management practice in the hospital. Routine use of an alcohol screening tool can enable early identification of the alcohol use disorder and to improve the management of this problem in the hospital.
引言和目的
据估计，与酒精相关的发病率在医院急诊科就诊患者中占 10-38%。本研究旨在调查澳大利亚一所教学医院中与酒精相关就诊的实际管理流程。
设计和方法
对 2016 年 11 月至 2017 年 2 月期间出院时主要或次要诊断为“酒精使用障碍”的 210 例患者的电子病历进行回顾性审核。调查了六个关键管理步骤：酒精使用障碍的识别、记录、硫胺素、酒精戒断评估、酒精戒断时使用苯二氮䓬类药物以及转至药物和酒精咨询联络服务。
结果
在所有 210 例就诊者中，77.1%（162 例）在初次评估中确定有酒精使用障碍；64.3%（135 例）记录有酒精使用史，49.5%（104 例）开具了硫胺素，48.1%（101 例）接受了酒精戒断量表评估，41%（86 例）开具了酒精戒断时使用的苯二氮䓬类药物，仅 38.6%（81 例）转至药物和酒精咨询联络服务。仅有 8.6%（18 例）的初始就诊与酒精直接相关。这些直接与酒精相关的就诊者在六个步骤中的完成率均高于那些（91.4%，192 例）不直接与酒精相关的就诊者。仅 6.2%（13 例）接受了正式的酒精使用筛查。
讨论和结论
研究结果表明，医院需要改进酒精管理实践。常规使用酒精筛查工具可以早期识别酒精使用障碍，并改善医院对该问题的管理。
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