Our hospital medicine practice noted a high number of admissions and readmissions to the internal medicine service for the specific purpose of acute detoxification from alcohol dependence. We noted a lack of a clear system for determining which patients would benefit from inpatient detoxification vs. those who might be safely treated as an outpatient. We also noted a lack of coordination between the hospital and community alcohol dependence treatment.
(1) Develop an evidencebased protocol to evaluate alcohol dependent patients requesting inpatient alcohol detoxification, specifically addressing safety of outpatient detoxification and identifying risk factors for complicated alcohol withdrawal, (2) Improve coordination with community resources for alcohol dependence treatment, (3) Measure specific metrics before and after implementation of the protocol to see if protocol would impact utilization of inpatient services.
We formed a task force to develop a protocol for alcohol detoxification. The task force reviewed best available evidence on acute alcohol dependence treatment. We found limited data, with majority of literature focusing on predictors of delirium tremens, and these risk factors informing expert opinion on need for inpatient vs. outpatient treatment for alcohol detoxification. Accordingly, we reviewed evidence on predictors of delirium tremens in developing our protocol. Briefly, the developed protocol calls for careful assessment of risk factors for complicated withdrawal coupled with Clinical Institute Withdrawal Assessment (CIWA) scores, in the context of patient history. We met with representatives from the largest community alcohol treatment facility, and the protocol incorporates a process for referring patients to alcohol dependence treatment. After providing a period for commentary and modification, we implemented the protocol July 1, 2011. Metrics to be followed will include number of admissions to inpatient service for specific purpose of alcohol detoxification, 30day readmission rate, and length of stay index before and after implementation of protocol. Other metrics may be added as data are further analyzed, including number of referrals to community alcohol treatment facility.
For the 6 months preceding initiation of protocol, there was an average of 18.33 admissions/month for alcohol detoxification, with a 20% 30day readmission rate and length of stay index of 0.61. For the 2 months following initiation of protocol, there was an average of 11.5 admissions per month with a 17.5% readmission rate and a length of stay index of 0.92. Thus, it appears that with use of a standardized protocol, patients with alcohol dependence presenting for substance abuse can be systematically evaluated for need for inpatient vs. outpatient treatment. Utilization of the protocol appears to lower admissions to the hospital and 30day readmission rates for alcohol detoxification.
To cite this abstract:Liles A, Stephens J, Kirsch J, Stepanek K, Gilchrist M, Dancel R. Who Needs Detox? A Protocol for Evaluation of Patients with Alcohol Withdrawal. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97717. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/who-needs-detox-a-protocol-for-evaluation-of-patients-with-alcohol-withdrawal/. Accessed July 21, 2019.