Aintree University Hospital

University Hospitals of Liverpool group

Gained IQILS accreditation in 2024

Aintree University Hospital serves a secondary care population of about 350,000 patients in North Liverpool, South Sefton and Knowsley. Our secondary care population includes a number of the most deprived neighbourhoods in England. Associated with this is a significant burden of alcohol use disorder and hard to reach individuals, who may have problems with alcohol dependency, alcohol-related illnesses, (including alcohol-related liver disease – ArLD), and related psycho-social issues.

We try to provide the best support possible to our cohort of patients, and with the awareness that these patients don’t often seek help outside of a crisis, we have come up with a number of methods to try and opportunistically engage when they come into contact with services to try support them moving forward.

Over the last year our alcohol nursing team have implemented an electronic referral system on our EPR that allows staff to refer by electronically completing an AUDIT C form. This feeds into a dashboard which allows us to track how many patients we see within 24 hours of the referral. Out of the 1278 referrals we have received so far this year, 97% were seen and assessed within 24 hours. This then facilitated early discharge for suitable patients and implementation of care plans regarding alcohol withdrawal medication, to ensure those at high-risk of seizures, Delerium Tremens, or ArLD are given the optimal treatment promptly.

To reduce the clinic burden on our patients, while accepting that non-compliance may be a problem, we have streamlined our services. We see many patients in our alcohol treatment clinics, which focus on anti-craving and positive reinforcement to achieve abstinence and monitor the progression of ArLD. These run parallel to consultant led hepatology clinics. Additionally, we run telephone clinics, a telephone hotline and our emergency hot clinic focusing on outpatient detoxes, providing options for admission avoidance in addition to advice on safe drinking and alcohol reduction strategies.

With a team of 6 nurses and a band 4, we provide a 7 day service, as well as supporting ward training, doctors’ inductions, IP FibroScans, audits, training days, MOCA’s, health promotion stalls, referrals to community services and detox centres. As a team we also support our research nurses, highlighting patients who may be eligible for the BASIS study, evaluating the effectiveness of Baclofen as an anti-craving agent. We have well established links with the mental health team and community alcohol and drug service staff, to enable a smooth transition from hospital alcohol care to the community and help prevent attendances to AED.  Attending frequent attenders’ meetings with the trust also ensures we are promoting admission avoidance so that repeat patients have care plans in place to reduce AED presentations.

Although our team provide a vast range of services, we still have challenges. Increasingly, one is supporting patients who have alcohol related cognitive impairments. This cohort of patients continues to present an un-met need with very sparse services available, especially for those who are unable to live independently and of a relatively young age.

Thank you to the Aintree hepatology team for their contribution and continued excellence.