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Hospital trauma teams urged to help combat alcohol related injuries and deaths

01 April 2010

The Royal College of Surgeons of England is today challenging nurses, doctors and surgeons working in NHS trauma services to help curb the epidemic of alcohol misuse by providing advice to patients during their course of treatment. Clinical trials show that of hazardous drinkers who receive a ‘brief intervention’ at follow up appointments following a hospital admission for trauma, 24 per cent more reduce their drinking to safer levels a year later compared to those who don’t*. The new standard affirms that this should be a routine and expected part of surgical care.  

The ‘brief intervention’ consists of simple advice delivered by clinical staff to patients with an alcohol problem, and motivates them to stop abusing alcohol.  Trials have demonstrated that in the aftermath of injury and surgery, when patients attend outpatient clinics to have stitches removed or dressings changed, a unique “teachable moment” arises, which can be used to screen for alcohol misuse and help patients to reduce their drinking. This treatment is also cost-effective as it does not require additional staff and fits in with current practice.

Alcohol misuse is a major cause of injury and trauma death, and costs the NHS and other public services around £20billion each year. The UK Burden of Injuries Study of 2007 showed there were 7.98 million injury related A&E attendances and 751,000 injury related hospital admissions for the 60.6 million UK population in 2005/6. 30 per cent of these are associated to some extent with alcohol misuse. This works out at over 2 million alcohol related A&E injury attendances each year.

The Royal College of Surgeons says that the surgery, nursing and emergency professions can best support the Government strategy to reduce misuse of alcohol [the National Alcohol Strategy – Safe, Sensible, Social], by identifying patients who abuse alcohol and motivating them to drink sensibly.  This new policy from the RCS defines a new standard of care and expects all surgeons to act by increasing awareness among colleagues and identifying ways in which this treatment can be facilitated and delivered in their hospitals.   The Government in Wales has already funded nurse training in this area and is adopting formally this approach. 

Jonathan Shepherd, a member of RCS Council and Professor of Oral and Maxillofacial Surgery, said:

“As a surgeon I am confronted on an almost daily basis with the aftermath of alcohol related injuries particularly through violence.  Although many of the young people who end up in A&E have been drinking heavily, they are generally not alcohol dependent. I urge colleagues and hospital Trusts to take the initiative now and engage with this group of patients before they become repeat visitors.  By the time patients attend outpatient clinics for the removal of stitches, or other treatment, they have had time to reflect on the cause of their injuries, and this offers an excellent opportunity for clinic nurses to motivate them to drink sensibly.”

Dr John Heyworth, President of the College of Emergency Medicine said,

“The impact of alcohol use and the effects of alcohol intoxication on behaviour, including social disorder and lawlessness often spill over into the hospital environment, particularly Emergency Departments (EDs). Previously a weekend problem, confined mostly between 10pm and 2am, dealing with severely intoxicated patients is now a 24 hour / 7 day a week issue. Most surprisingly the people who do report are often the young but also increasingly the educated middle class and elderly. So it is essential that we are thinking about how we can intervene and help curb this behaviour long term.”

Janet Davies, Executive Director of Nursing & Service Delivery at the Royal College of Nursing (RCN), said:

“Nurses frequently see the devastating effects of excessive drinking on people’s physical and psychological health. The time nurses spend with patients during follow-up appointments provides a valuable window of opportunity to encourage people to think about whether they might be drinking too much and to signpost them to further information and advice. All healthcare professionals should be armed with the necessary knowledge and skills to help patients drink sensibly. The RCN has accredited a training module to provide nurses with the skills they need to conduct the intervention.”

The RCS Policy statement can be found here.

Notes to Editors:

  1. *” at 12-month follow-up 51% of the control group were above recommended levels compared to only 27% of the intervention group.”  A. J. Smith, R. J. Hodgson, K. Bridgeman & J. P. Shepherd; A randomized controlled trial of a brief intervention after alcohol-related facial injury. Addiction, 98, 43–52
  2. References:
    1. Reducing alcohol misuse in trauma and other surgical patients – position statement, Royal College of Surgeons, 2010
    2. A. J. Smith, R. J. Hodgson, K. Bridgeman & J. P. Shepherd;  A randomized controlled trial of a brief intervention after alcohol-related facial injury. Addiction, 98, 43–52
    3. Violence in England and Wales 2008 (J Shepherd) http://www.vrg.cf.ac.uk/Files/NVSN_2008.pdfAn e-learning module been accredited by the RCN Accreditation Unit, which means that nurses can count completion of the module towards their reflective learning requirements. The module takes less than two hours to complete and provides practitioners with the information and skills they need to deliver IBA, including details on units and the risks associated with alcohol consumption.  It is freely available to all staff in the NHS and community services via the Alcohol Learning Centre. (www.alcohollearningcentre.org.uk/elearning).
  3. The Royal College of Surgeons of England is committed to enabling surgeons to achieve and maintain the highest standards of surgical practice and patient care. Registered charity number: 212808. For more information please visit www.rcseng.ac.uk
  4. If you have any queries please contact:

Matthew Worrall - Email: mworrall@rcseng.ac.uk; T: 020 7869 6047

Elaine Towell - Email: etowell@rcseng.ac.uk; T: 020 7869 6045

Heather Casey - Email: hcasey@rcseng.ac.uk; T: 020 7869 6042

Out-of-hours: 07966 486 832