Centre for Rural Emergency Medicine Part of NHMRC Grant for Alcohol Research

A 2015 alcohol screening pilot project undertaken at South West Healthcare Emergency Department has contributed to the awarding of a $1.5M research grant.

The Federal Government’s National Health and Medical Research Council (NHMRC) has announced South West Healthcare is part of a winning consortium to deliver the Driving Change: Using Emergency Department Data To Reduce Alcohol-related Harm pilot to emergency departments throughout Australia. SWH’s share of the funding will be approximately $100,000 over five years.

The NMHRC is Australia’s leading expert body for supporting health and medical research; developing health advice for the Australian community, health professionals and governments; and providing advice on ethical behaviour on health care and in the conduct of health and medical research. Becoming the recipient of an NMHRC grant is incredibly prestigious.

Joining SWH, the winning consortium includes Deakin’s Centre for Social and Early Emotional Development (SEED), Vincent’s Hospital Australia (Melbourne and Sydney), the Australasian College for Emergency Medicine, Australian National University, Barwon Health, Calvary Health Care ACT, Monash Health, University of New South Wales, and Cardiff University.

SEED’S Professor Peter Miller will lead the five-year project based on an international model that has shown to substantially reduce violent crimes, street assaults and hospital admissions related to alcohol. Building on the international evidence and pilot data gathered from Warrnambool and other Australian emergency department sites last year, he will oversee and evaluate an intervention that aims to reduce alcohol-related injury in the community through a randomised trial in eight emergency departments in Victoria, NSW and the ACT. A key aspect will be the introduction of mandatory ’last-drinks’ data collection within existing hospital IT systems that identifies areas of problem drinking.

‘Driving Change: Using Emergency Department Data to Reduce Alcohol-related Harm has the potential to improve the wellbeing of Australians,’ says the Director of the Centre for Rural Emergency Medicine’s Dr Tim Baker, who was heavily involved in last year’s pilot.

‘We are keen to continue to be involved so that the needs of rural patients and their families are considered, as well. Reducing the impact of alcohol and other drugs is our emergency department’s number one public health priority. Our share of the grant will allow a researcher to gather the information we need to find out what approach works best.’

According to the Australian Institute of Health and Welfare, over the past decade the number (from 40,000 – 60,000+) and rate (from about 200 – 270 hospitalisations per 100,000) of alcohol-related hospitalisations have risen annually.

SWH’s 2015 research highlighted the growing problem of ‘pre-loading’ – drinkers consuming vast amounts of (cheaper) alcohol at home before heading out to a licensed venue. The eight-month study asked people presenting with injuries at the Emergency Department whether they’d consumed alcohol in the 12 hour lead-up to their injury, and where they’d bought the alcohol they had at home before heading out for a night on the town.

The research also revealed Warrnambool’s May Racing Carnival is the peak time for alcohol-related injuries.

Extra alcohol and drug support for Warrnambool Emergency Department

Warrnambool Base Hospital will receive a $500,000 boost to help its emergency department better respond to patients affected by alcohol and drugs, such as ice,Premier and Member for South West Coast Dr Denis Napthine announced today.

“Drug and alcohol-affected patients can be challenging for emergency departments, in particular patients who are under the influence of new and emerging drugs such as ‘ice’,” Dr Napthine said.“This funding will ensure the hospital has the resources it needs to deal with these challenges.”

Dr Napthine said the local emergency department would now decide which new resources will best suit the needs of the local Warrnambool community, which could include hiring a new specialised alcohol and drug specialist or additional training for existing staff.

The initiative builds on the successful initiative announced in the 2012-13 Budget that provided 21 health services, including six regional health services, with additional resources to respond to alcohol and drug-affected patients.

The funding will also complement new laws introduced into Parliament this year that will better protect doctors, nurses and emergency personnel.“In June, the Government introduced legislation that increases the sentence for seriously assaulting an emergency department doctor or nurse to a minimum of six months,” Dr Napthine said.“These reforms were also expanded this week to create a minimum six-month sentence for serious assaults against staff anywhere in a hospital.”

The additional funding announced today follows the $5.7 million, 5.4 per cent increase to the 2014-15 South West Healthcare budget announced earlier this month. “Since coming to Government, the Coalition has been proud to deliver a $26.7 million, 31.4 per cent boost to the South West Healthcare Budget,” Dr Napthine said.


Last drinks: mapping alcohol harm in the country

Packaged liquor sales are acting as a major contributor to alcohol-related harm in rural areas, according to a new study published in Emergency Medicine Australasia, the journal for the Australasian College for Emergency Medicine (ACEM).

In the eight-month study, people presenting with injuries at an emergency department in rural South West Victoria were asked a series of questions including whether they had consumed alcohol in the 12 hours prior to injury, how much they had drunk and where they had bought most of the alcohol.

60% of respondents had bought most of their alcohol at packaged liquor outlets like bottle shops or supermarkets, the study found.

Approximately a quarter of these had gone on to have further drinks – including their ‘last drink’ prior to injury – at a licensed venue or public event.

“This is the first study of its kind to effectively map the source of alcohol-related ED attendances in a rural community,” said Associate Professor Peter Miller, lead researcher on the study, “It allows for the identification of problematic licensed venues and public areas and opens up great opportunity for further intervention; it’s a powerful tool to help communities tackle the problem of alcohol harm.”

Over half of the respondents who had bought most of their alcohol at packaged liquor outlets had consumed their last drink before injury at home, adding to the body of evidence that indicates many problem drinkers ‘pre-load’ at home with alcohol bought at a bottle shop or supermarket.

“The permissive culture that exists around the advertising, regulation and taxation of alcohol needs to be urgently addressed if we want to diminish the amount of harm it causes,” said Associate Professor Diana Egerton-Warburton, Chair of the ACEM Public Health Committee and Clinical Lead on the ACEM Alcohol Harm in Emergency Departments (AHED) Project.

There was also scope to introduce further measures to help reduce the harm caused by alcohol, Associate Professor Egerton-Warburton said.

“An effective brief intervention program – whereby drunks coming into the ED are screened and possibly referred for further treatment – could reduce the number of bloody idiots that we end up having to deal with,” she said, “Our research suggests that these drunks are often violent to staff, adversely affect other patient care and use a huge amount of resources.”

Dr Miller worked with Researchers from the Centre for Rural Emergency Medicine to add questions to a computerised triage system. “These data were generated with minimal cost, great cooperation among staff and no impact to the quality of patient care,” added Associate Professor Miller, “We’re already refining this model and hope to be engaging in a much larger trial very soon.”


Last drinks: A study of rural emergency department data collection to identify and target community alcohol-related violence

Alcohol-related violence and injury is a significant public health problem and a substantial burden on hospital EDs, especially on weekends during ‘high-alcohol hours’.

In this study by Peter Miller and Nic Droste, from Deakin School of Psychology, and Tim Baker from CREM, all patients aged 15 years or older presenting to a regional emergency department  were asked whether alcohol was consumed in the 12 hours prior to injury, how many standard drinks were consumed, where they purchased most of the alcohol and where they consumed the last alcoholic drink.

The study found that this ED data collection was feasible, alcohol injuries were linked to identifiable venues and public areas, and packaged liquor sales substantially contribute to emergency department attendances.

Access article on publisher’s site

Miller P, Droste N, Baker T, Gervis C. Last drinks: A study of rural emergency department data collection to identify and target community alcohol-related violence. Emergency Medicine Australasia 2015, Jun;27(3):225-31.

Emergency department data sharing to reduce alcohol-related violence

This paper reviews the current evidence for reducing alcohol related injuries by sharing data collected by emergency departments, with agencies such as police, local council, liquor licensing regulators and venue management.

Nicolas Droste and Peter Miller from the School of Psychology at Deakin University, along with Tim Baker from CREM, performed a quantitative and narrative synthesis on 8 articles selected from an original search of 19,506 articles.

All studies found that data collection could be cheaply and easily implemented into modern ED triage systems. All but on study study reported substantial reductions to assault or injury. One reported no change.

Access article on publisher’s site

Droste, N., Miller, P., & Baker, T. (2014). Review article: Emergency department data sharing to reduce alcohol-related violence: A systematic review of the feasibility and effectiveness of community-level interventions. Emergency Medicine Australasia, 26(4), 326-35. doi:10.1111/1742-6723.1224