Who Needs Inpatient Detox? Development and Implementation of a Hospitalist Protocol for the Evaluation of Patients for Alcohol Detoxification

• Published in: Journal of general internal medicine : JGIM Vol. 29; no. 4; pp. 587 - 593
• Main Authors: Stephens, John R., Liles, E. Allen, Dancel, Ria, Gilchrist, Michael, Kirsch, Jonathan, DeWalt, Darren A.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.04.2014; Springer; Springer Nature B.V
• Subjects: Advisory Committees - standards; Advisory Committees - trends; Alcoholism; Alcoholism - diagnosis; Alcoholism - therapy; Biological and medical sciences; Clinical Protocols - standards; Desintoxication. Drug withdrawal; General aspects; Health participants; Health Services Needs and Demand - standards; Health Services Needs and Demand - trends; Hospitalists - standards; Hospitalists - trends; Hospitalization - trends; Humans; Internal Medicine; Medical sciences; Medicine; Medicine & Public Health; Original Research; Patient admissions; Program Development - standards; Prospective Studies; Protocol; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Public health. Hygiene; Public health. Hygiene-occupational medicine; Substance abuse treatment; Treatments; hospital medicine; alcohol withdrawal; quality improvement; alcohol detoxification; Human; Evaluation; Ethanol; Indication; Health staff; Detoxification; Physician; Alcohol; Patient; Hospital environment; Hospitalization; Implementation; Alcoholic beverage; Need; Development; Hospital
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-013-2751-3

ABSTRACT BACKGROUND Clinicians caring for patients seeking alcohol detoxification face many challenges, including lack of evidence-based guidelines for treatment and high recidivism rates. OBJECTIVES To develop a standardized protocol for determining which alcohol dependent patients seeking detoxification need inpatient versus outpatient treatment, and to study the protocol’s implementation. DESIGN Review of best evidence by ad hoc task force and subsequent creation of standardized protocol. Prospective observational evaluation of initial protocol implementation. PARTICIPANTS Patients presenting for alcohol detoxification. INTERVENTION Development and implementation of a protocol for evaluation and treatment of patients requesting alcohol detoxification. MAIN MEASURES Number of admissions per month with primary alcohol related diagnosis (DRG), 30-day readmission rate, and length of stay, all measured before and after protocol implementation. RESULTS We identified one randomized clinical trial and three cohort studies to inform the choice of inpatient versus outpatient detoxification, along with one prior protocol in this population, and combined that data with clinical experience to create an institutional protocol. After implementation, the average number of alcohol related admissions was 15.9 per month, compared with 18.9 per month before implementation ( p  = 0.037). There was no difference in readmission rate or length of stay. CONCLUSIONS Creation and utilization of a protocol led to standardization of care for patients requesting detoxification from alcohol. Initial evaluation of protocol implementation showed a decrease in number of admissions.