Alcohol Harm in Emergency Departments (AHED) Program

The AHED program conducts research into the extent and impact of alcohol harm in our EDs, is trialling initiatives to monitor and reduce alcohol and other drug harms, and advocates for alcohol policy reform. 

We have an expert advisory group who advocate on alcohol and other drug harms in EDs in Australia and New Zealand. Assoc Prof Diana Egerton-Warburton, Clinical Lead for the AHED program, is a member of the Australian National Advisory Council for Alcohol and Drugs (ANACAD).

ACEM is a member of the National Alliance for Action on Alcohol (NAAA), the Victorian Alcohol Policy Coalition (APC) and the New South Wales and ACT Alcohol Policy Alliance (NAAPA).

Context
Research
Policy recommendations
BI App Pilot
Australia Day 2016 Snapshot
Alcohol Harm Snapshot 2016


Emergency departments in Australia and New Zealand are at the forefront of dealing with the harmful effects of alcohol consumption. Alcohol-related presentations to our emergency departments have a signficant effect on other patients, workforce morale, and the functioning of the ED.

Alcohol is a major cause of preventable, non-communicable disease and injury worldwide. Alcohol contributes to 3.3 million deaths annually.

One in five Australians and New Zealanders drink at a level that increases their lifetime risk of alcohol-related disease or injury. Almost half of Australians (44.7%) over the age of 18 reported consuming alcohol on a single occasion in the preceding year that put them at increased risk of acute injury.

There is no compulsory collection of alcohol–related presentations to EDs in Australia and New Zealand. As a result, alcohol-related presentations are underestimated in official reporting.

For information or enquiries contact Ange Wadsworth: angela.wadsworth@acem.org.au

 


Seven-day continuous survey of alcohol-related presentations

In the largest study of its kind ever undertaken, eight emergency departments across Australia and New Zealand were monitored over one week in December 2014. Over 9,600 patients were screened. 

The study found that at peak times, one in eight presentations to emergency departments (EDs) are alcohol-related. 

Almost one in 10, or 9.5% of all presentations 24/7 were alcohol-related.
 
That equates to more than half a million alcohol related patients attending EDs every year across Australia and New Zealand. The study confirms that alcohol is having a major impact on our emergency departments.
 
The survey also found that alcohol-affected patients were more likely to require urgent resuscitation and arrive by ambulance and with police. 

A journal paper is currently being prepared for publication.


Seven-day Survey Media Release: 25 November 2015.


Survey of ED clinical staff perceptions of alcohol–related presentations

In June 2014 ACEM surveyed over 2000 clinicians about their experiences of alcohol-affected patients in emergency departments. This is the largest survey of its kind to be undertaken in Australia and New Zealand. The survey results confirm that alcohol has a serious impact on staff and other patients in our emergency departments. The findings were released at a public event in November 2014.

The survey findings have been published in the Medical Journal of Australia.

Egerton-Warburton D, Gosbell A, Wadsworth A, et al. Perceptions of Australasian emergency department staff of the impact of alcohol-related presentations. Med J Aust 2016; 204 (4): 155


Survey findings:

Two snapshot surveys

This is the first large-scale bi-national survey work to quantify the rate of alcohol-related presentations during a weekend evening night shift in a broad range of public hospital EDs.

Snapshot 1: (2am, 14 December 2013)
This survey found that one in seven patients (14%) were in the emergency department because of alcohol.

Media releases:
Australia
New Zealand

The survey findings have been published in the Medical Journal of Australia.

Egerton-Warburton D, Gosbell A, Wadsworth A, Fatovich D, Richardson D. 2014. Survey Confirms Alcohol-Related Presentations To Australasian Emergency Departments are Under-Reported. Med J Aust 2014; 201 (10): 584-587.

Snapshot 2: (2am, 6 December 2014)
In this second survey the percentage of alcohol-related presentations was 12% (one in eight patients).

Media releases:
Australia
New Zealand 

Survey findings are currently being prepared for publication.

For information or enquiries contact Ange Wadsworth: angela.wadsworth@acem.org.au
 

ACEM calls on governments in Australia and New Zealand to:

1. Introduce compulsory collection of alcohol-related ED presentation data

Add emergency department alcohol-related presentations to patient data sets:

Mandatory collection of this data would provide:
• a clearer picture of the extent of alcohol-related presentations to hospital
• an evidence base to inform and evaluate policy decisions.

2. Introduce a preventative health program for emergency departments

Screening, brief intervention and referral for treatment (‘Brief Intervention’) program for alcohol-affected patients in emergency departments.

International research suggests that Brief Intervention can be an effective tool to identify, reduce and prevent problematic use, abuse, and dependence on alcohol and other drugs.

3. Address alcohol regulation and advertising

International evidence shows that when hours and days of sale are decreased, consumption and harm decrease, and vice versa.

• Introduce 3am as the latest time for serving alcohol in pubs and clubs
• Maintain and extend the freeze on granting new late night licenses
• Introduce 10pm as the latest time for packaged liquor sales

Control the advertising and promotion of alcohol, particularly to young people

• Young people are regularly exposed to advertisements depicting alcohol consumption as social, fun and inexpensive
• We would like to see greater efforts made to protect young audiences up to 25 years from alcohol advertising, and the phasing out of alcohol sponsorship in sports
• Alcohol advertising in Australia is self-regulated by the alcohol and advertising industries. ACEM supports the establishment of an independent regulatory body for alcohol advertising, sponsorship and promotions.

Tax alcohol products according to their alcohol content, not their price.

Alcohol products in Australia are taxed differently according to type, packaging, alcohol content and cost. The greatest discrepancy in the current system is the wine equalisation tax (WET). Wine is taxed according to its retail price rather than its alcohol content, resulting in cheaper wines attracting far less tax. ACEM supports measures to tax alcohol products according to their alcohol content.

For information or enquiries contact Ange Wadsworth: angela.wadsworth@acem.org.au

HSM_Stacked_Blue.jpgThis project trialled an app to allow emergency department physicians to identify hazardous drinkers and offer them a Brief Intervention (BI) and referral if required.

The app enables physicians to screen for harmful drinking on their smart phones, using the WHO Alcohol Use Disorder Identification Tool (AUDIT), and where appropriate, follow with a referral to Hello Sunday Morning to reduce their alcohol consumption.


The aim was to develop a feasible, sustainable BI for emergency department patients, coupled with an ongoing opportunity to reduce harmful drinking. Three Victorian emergency departments piloted the innovation in 2016. An evaluation of the project will be completed by December 2016. 

ACEM gratefully acknowledges funding from VicHealth.

For information or enquiries email angela.wadsworth@acem.org.au

Research conducted by the Australasian College for Emergency Medicine (ACEM) has found that one in seven patients attending Australian emergency departments (EDs) on Australia Day were there as a result of alcohol harm.
 
The snapshot survey was the largest of its kind ever undertaken in Australia and the first to investigate the relationship between alcohol harm and our national day.
 
It revealed that at 11pm on 26 January 15% of patients across 100 EDs were there as the result of alcohol.
 
'That represents a huge and entirely unnecessary burden being placed on our already over-stretched emergency departments,' said Associate Professor Diana Egerton-Warburton, Chair of ACEM’s Public Health Committee and clinical lead for ACEM’s Alcohol Harm program. 'Clinicians are desperate for community action.'
 
Associate Professor Egerton-Warburton said that some of the factors contributing to excessive drinking were already well understood. These included extended trading hours, cheap prices and heavy promotion.
 
'For every additional late trading hour, there’s a 20 per cent increase in serious assaults and injuries,' she said, 'States like NSW and Queensland are already taking a lead on introducing early last drinks to help address this tide of human tragedy that arrives in our EDs.'
 
'We need to have a national agreement on safe alcohol trading hours. It will save lives.'
 
Professor Drew Richardson, the survey’s lead researcher, said that this was the third snapshot survey ACEM had undertaken. As with the previous surveys, it demonstrated unequivocally that Australia had a problem with alcohol.
 
'We need a profound societal shift in our attitude to alcohol consumption, and not just on Australia Day,” Professor Richardson said. 'This is a massive public health problem and a major issue for the safety and effectiveness of our staff.'
 
Researchers from the Australasian College for Emergency Medicine (ACEM) conducted the survey, with funding provided by the Australian Rechabite Foundation (ARF).

Australia Day 2016 Snapshot Survey Media Release

ACEM gratefully acknowledges funding received by the Australian Rechabite Foundation

For information or enquiries email angela.wadsworth@acem.org.au

The latest snapshot survey of alcohol-related presentations to emergency departments (EDs) in Australia and New Zealand has shown once again that alcohol continues to impact on staff, patients and health systems in both countries.  

In Australia the survey revealed that one out of eight patients were there as a result of the harmful use of alcohol. While In New Zealand, the survey shockingly revealed that one out of four patients were there as a result of the harmful use of alcohol.    

“We continue to see our already over-stretched EDs being placed under terrible strain by individuals who drink far too much,” said Associate Professor Diana Egerton-Warburton, study author and lead of ACEM’s Alcohol Harm in the ED project. “Emergency doctors and nurses are sick and tired of having to deal with drunks who take up valuable resources and sometimes abuse or even physically attack staff, so if you’re going to drink, do it responsibly because we don’t want to see you in the ED this holiday season!” 

“This survey was our biggest yet” says research lead Professor Drew Richardson. “In over 130 hospitals across Australia and NZ we can see alcohol is still seriously affecting patients and resources. Some hospitals had up to 24 alcohol affected patients and in two smaller hospitals, every single patient was there because of alcohol.” 

“While this is a very small improvement from our last survey, which had one in seven patients in Australian EDs due to alcohol harm, we still have a long way to go to reduce irresponsible drinking in Australia.”   
Professor Anthony Lawler, ACEM President, said that alcohol harm was a complex public health issue, but that ways to reduce it were clearly understood.  

“Examples from overseas – as well as the considerable research that ACEM and other organisations have done in Australia and New Zealand – indicate that there are a range of measures that can be pursued to curb the level of harm caused by excessive drinking,” Professor Lawler said. “These include reducing the availability of alcohol, increasing the price through taxation, and looking at its promotion and advertising, especially directed at young people through sport.”  

There had been a considerable reduction in the levels of violent assault in New South Wales after policy-makers addressed only one of these criteria, Professor Lawler noted.  

“How much more suffering could be avoided if states and territories made moderate, sensible changes to the cost of alcohol and its currently extremely high level of advertising?”  

Associate Professor Diana Egerton-Warburton says “Australia needs to follow NZ’s lead and mandate the collection of data on alcohol-related harm in EDs, which will allow a much better idea of the scale of the problem. It then needs to be followed up with reducing availability and increasing price.” 

2016 Australian Snapshot Survey Media Release

2016 New Zealand Snapshot Survey Media Release

For information or enquiries email angela.wadsworth@acem.org.au