PTH-062Emergency Admissions For Alcohol Related Conditions: Making Sense Of Routine Data

IntroductionAlcohol-related emergency admissions (ARA) are a major and rising hospital burden, resulting from conditions that range from short-term toxicity to end-stage organ damage, notably liver disease. We report a project to develop analyses of routine coding data, with a particular focus on metrics related to 'frequent flyers' (FFs) as targets for new service interventions.MethodsSources of data: Hospital Episode Statistics for all English hospitals (2006-2008); Inpatient coding data and AED attendances for our Trust (2006-2013).Analysis: Screening of all non-emergency episodes for alcohol-related codes at any position to flag ARAs; linkage of individual cases to extract all admissions and order chronologically; allocation of each admission to a category based on primary and lower order diagnoses (flagging LIVER and NON-LIVER admissions); identification of frequent flyers (FFs) based on various definitions of admission count; linkage of ARAs to all-cause AED attendances in local data; funnel-plot analyses of patterns across English Trusts; longitudinal trends in local data.ResultsNationally: 219,158 ARAs in 139,077 patients (2006-2008), mean age (sd): 49.5 yrs (16); males: 99,271 (71%); Deprivation : Quintile 1 (most deprived) 36.4%, Quintile 5 (least): 9.4%; Co-morbidity (Charlson), 0.44 (0.68); LoS: 7 (14) days; Inpatient death: 6,656 (4.8%). No. admissions ranged from 1-60 per individual. Frequent Flyers: In two years, a cut-off of 5+ admissions identified 5,404 FFs (4% of patients; accounting for 18% of ARAs nationally) whereas 10+ identified 909 FFs (1% of patients; 6% of ARAs). Mean ARAs per Trust was 927 (range: 235-3930) with 6-fold variation in% of FFs (1.3% to 7.7%) and 4-fold variation in% with liver disease across English hospitals (range: 7.6-30.2%). As expected, FFs coded with liver disease had significantly higher LoS and mortality risk consistent with end-stage organ damage and "unavoidable" admissions.Locally: 21,308 ARAs in 16,305 patients (2006-2012), with annual number of cases rising from 1,615 to 4,603. Defining FFs as 5+ ARAs per year, there were 320 FFs (2% of patients; 10% of ARAs). There was a year-on-year rise in ARAs (2,454-5,510) and AED attendances without admission (2,499-5,979). However, FFs (5+ admissions) declined from 64 to 47 between 2006 and 2012 and non-liver FFs from 25 to 12, suggesting a positive impact of new local services on multiple attenders, especially those lacking established liver disease.ConclusionWe