The new Alcohol Care Team funded by the Hounslow Borough Based Partnership for two-years (2022-24) surpassed targets, with the number of alcohol related admissions significantly reducing against baseline objectives.
The project outcomes for Year 1 were so successful after the new seven day a week Alcohol Care Team (ACT) was implemented at West Middlesex University Hospital, that the project received Better Care Funding to support delivery into 2025.
What is ACT?
ACTs provide specialist alcohol treatment provision within acute hospital settings and aims to:
• provide alcohol screening and brief interventions
• upskill other hospital staff to screen and identify alcohol issues in patients
• provide optimal clinical care for patients struggling with alcohol dependency whilst in hospital
• reduce bed days by moving patients out of hospitals with appropriate care plans
• move people into community treatment services thus reducing future alcohol related admissions
In February 2022, the five-person Alcohol Care Team, with support from an Addiction Psychiatrist, began work in WMUH. The model included the following roles:
• Band 7 nurse (team leader)
• Band 6 nurse (background in gastroenterology)
• 2 Band 5 Recovery Workers
• 1 Peer Support Worker
• Sessional oversight from an Addiction Psychiatrist
Data Outcomes
Table 1.0 and 1.1 demonstrate the targets that were set for year 1 (February 2022-January 2023):
The number of people who have received extended brief interventions and who have started structured treatment is seen as a really successful outcome of the joint work between the hospital and the community setting and the skill mix in the team
Additional Outcomes
Training
- Staff training has been an ACT priority. Post completion of a staff survey to ascertain staff level of knowledge, bespoke training was designed.
- The first session was delivered jointly by the ACT Team Leader and the Acute Medicine/Gastro Registrar to Foundation Doctors at the end of July 2022. Further training sessions since have included a ‘Grand Round’ where alcohol care training was delivered to a large group of doctors and training specifically for ED nurses, mental health nurses and for Ambulatory Emergency Care nurses as well as inpatient wards.
- The ACT have delivered training to junior doctors as part of the rotational training organised by the learning and development team.
Communications
- The ACT and Dr Emma Rowlandson continue to jointly promote the team within the hospital, including at the Trust’s ‘Public Health Deep Dive’.
- Promotional video highlighting the ACT; the rationale for the project, the impact so far, the relation to inequalities and the partnership approach, was produced in 2023 for staff.
Partnership with Psychiatry Liaison
- The ACT and the Hospital Psychiatry Liaison Team (HPLT) have been working closely together throughout the project, with consultants from HLPS and the ACT in regular contact, as are the staff working in ED.
- Most importantly patients have benefited from regular joint assessments and reviews which has meant joint working with the MINT and ARC for ongoing support. This is a significant development for patients who often suffer inequalities due to their co-morbidities.
Ambulatory Detox Pathways
- The ambulatory detox pathway proved challenging to implement, however this has now been agreed. Reviews of the initial cases in quarter 4, suggested that 10 bed days were saved. This pathway continues to be developed.
Treatment Engagement
- A primary focus has been on connecting those seen in hospital into treatment with ARC. A 7 day a week booking system, flexible follow up and outreach and the utilisation of the 12-week Recovery Day Programme as a pathway post detox, has proved very successful.
Data
- Ensuring accurate data has been challenging and resource intensive. The ACT, CNWL and WMUH have worked closely to sync the data over the separate operating systems (Systm1 and Cerner).
- Data is important to funders and vital for evaluation and improvement to the service, so must be prioritised. We would recommend extensive trialling of data prior to the start date of future projects
Recruitment and Staffing
- There is an ongoing challenge in terms of recruitment, particularly around experienced specialist nurses.
- A further unforeseen issue was that two members of the team have suffered from long term sickness.