Identifying Patients with ARLD on the Isle of Wight

1. Identifying Patients with ARLD on the Isle of Wight
Dr Leonie Grellier Consultant Gastroenterologist

2. Isle of Wight
• Population 140 500
• Socially deprived rural population – Ryde,
Newport, Ventnor
• 24% aged 65 or above
• One acute trust with 246 beds, 22000
admissions/yr
• At least 10000 adults drinking at increased risk
levels
• Evidence for significant under age drinking

3. Current provision for alcohol services
Community
treatment –
Butler Gardens
70/yr
GP
surgeries
?
Patient
self
referral
IRIS
community
3WTE band
4/5/6
800/yr
St Mary’s
No alcohol
team
1 consultant
Small numbers of
patients with MH
problems treated in
Sevenacres

4. Headline numbers: Isle of Wight NHS Trust
(AHSN data)
• During Jan 2011 – Dec 2015:
– There were 1,652 LD admissions
– There were 535 ARLD admissions (from 272 ARLD
patients)
– 36 % of all LD admissions had an alcohol-specific
condition recorded
– 92 % of all LD admissions were emergency
– 47% ARLD group died in hospital (39% non ARLD)
* Cost may be under-reported by up to 10%, as some admissions could not be assigned to a HRG tariff 4

5. Liver Disease/ARLD inpatient journey
St Mary’s IOW (2014-2015)
Key Narrative
This visualisation shows
the routes of admission
for Liver Disease and
ARLD through wards at
the Trust.
204 patients were
admitted to surgical
wards
In depth audit of
admissions reveals an
additional 27% of
patients with non ARLD
codes have evidence for
ARLD
Method of
Admission
Admitting
ward
ARLD/non-
ARLD
admission
5

6. IOW ARLD baseline audit
• Retrospective audit of acute admissions Jan-
March 2015 to St Mary’s Hospital, Newport.
• Undertaken by 2 CT2 and I SpR
• Using WAHSN audit tool template
• 61 sets of notes reviewed

7. IOW ARLD baseline audit 2015
Disease Group Number of
patients
Asked about
alcohol intake
(%)
Quantifiable
alcohol intake
(%)
Audit C
completed
(%)
ARLD 20 85 26 0
Alcohol group 26 77 29 0
Other LD 15 73 9 0
Total 61 79 24 0

8. IOW ARLD baseline audit 2015
Disease
Group
Number
of
patients
Patients
seen by
AIT
% given
brief
advice
% offered
community
alcohol team
ref
% patients offered
other support
(OPA)
ARLD 20 0 16 20 20
Alcohol group 26 0 0 15 23
Other LD 15 0 0 7 0
Total 61 0 5 15 16

9. IOW ARLD baseline audit 2015
• 15 patients coded as ‘other liver disease’
• 5 had direct or indirect evidence of ARLD
• Anecdotal evidence of referral to community
services ineffective
‘I can do it on my own’

10. Moving forward
• September 2016 baseline audit complete
• October – February 2016
– Stakeholder meetings CCG, PH, IRIS, Trust
CEO/MD
– Business case for inpatient team in development
– Training of front line staff in alcohol screening
– Audit of uptake of AUDIT C and CIWA in MAAU
– Presentation of results to ED / development of
screening

11. Moving forward
– Presentation at clinical standards group AUDIT C/
CIWA to adopt as standard screening tools
– Development of research project using
community pharmacies to screen and refer (more
later)
– Plans for integrated alcohol service presented at
JCB CCG 1st February
– Re audit planned Jan- March 2018

12. Integrated alcohol team
Community
treatment clinics
nurse/consultant
Pharmacies
Universal screening
GP
surgeries
Universal
screening
Patient
self
referral
IRIS
Team manager
–band 6/7
2WTE band 4/5
2WTE band 4/5
St Mary’s
2 WTE band 6/7
Admin 0.5
1WTE band 4,
Consultant 1 PA
(Pharmacy)
technicians)
Nurses work between
locations to provide 7/7
daytime service

13. Barriers to Improvement
• Start up costs of hospital and community
teams