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ERs See Dramatic Rise in Drunk Patients

By John Commins  
   January 19, 2018

In less than one decade the number of ER visits involving alcohol consumption increased 61.6%, from 3 million to 4.9 million, and the total cost increased 272%, from $4.1 billion to $15.3 billion.

The rate of alcohol-related visits to U.S. emergency departments increased by nearly 50% between 2006 and 2014, and the cost of providing care more than tripled, according to a new study from the National Institutes of Health.

"In just nine years, the number of people transported to the ED annually for medical emergencies caused or exacerbated by alcohol increased from about 3 million to 5 million," said NIAAA Director George F. Koob, director of NIH's National Institute on Alcohol Abuse and Alcoholism.

"These findings are indicative of the detrimental effects that acute and chronic alcohol misuse have on public health, and the significant burden they place on our healthcare system," Koob said.

Researchers gleaned data from the Nationwide Emergency Department Sample, involving 945 hospitals in 33 states. The results were published this month in the journal Alcoholism: Clinical and Experimental Research.

Among the key findings, between 2006 and 2014:

  • The number of ED visits involving alcohol consumption increased 61.6%, from 3 million to 4.9 million. The rate of all alcohol-related ED visits increased 47% between 2006 and 2014, which translates to an average annual increase of 210,000 alcohol-related ED visits.
  • The total cost increased 272% from $4.1 billion to $15.3 billion.
  • The number of acute alcohol-related ED visits increased 51.5% from 1.8 million to 2.7 million, and the rate increased 40% from 720.9 to 1,009.6 per 100,000 population.
  • The number chronic alcohol-related visits increased 76% from 1.3 million to 2.2 million, and the rate increased 58% from 502 to 793 per 100,000 population.
  • Men account for more alcohol-related ED visits than women, but the annual percentage change in rates of all alcohol-related ED visits was larger for women than for men (5.3% vs. 4%). This increase was driven primarily by a larger increase in the rate of chronic alcohol misuse-related visits for women than men (7% versus 4.5% annually).

"During the study period, the number of people in the United States who drank alcohol and the total amount of alcohol consumed each year remained about the same," said lead researcher Aaron White, a senior scientific advisor at NIAAA. "We suspect the increase in ED visits is related to an increase in the intensity of alcohol use among a subset of drinkers."

"Recent studies suggest that the drinking habits of females and males are becoming more similar in the United States," said White. "The larger increase in the rate of ED visits among females compared to males provides further evidence of narrowing gender gaps in alcohol use and related harms. This trend is concerning given that females appear to be more susceptible to some of the detrimental health effects of alcohol."

Hany Atallah, MD, chief of Emergency Medicine at Grady Health, was not involved in the NIH study but says the ER at Atlanta's safety net hospital deals with lots of intoxicated patients.

"In my mind it divides itself into two spectrums: No. 1 is the medical and No. 2 is the surgical," Atallah says. "No. 1, you’ve drank enough and fallen and hit your head and cut your face and broke a bone. We see that a good bit, and we do see it more in the older patient population. That is the surgical problem."

"The medical problems we see are people who have just been drinking long enough that they have managed to damage parts of their body. The volume has been increasing," he says.

"Obviously the surgical treatment is straightforward. You figure out if something is broken or bleeding and if it is, you need to figure out what you need to do about it," Atallah says. "For those who show up drunk, which is a fair bit, typically we are watching them until they are sober. Once they are sober and safe and if everything else is OK we discharge them."

"We do admit a fair number of chronic alcoholics for alcohol withdrawal. That is a problem as well. It takes up hospital resources and those people can get very sick," he says.

"On the flip side, for the folks who drink and sober up, if they are regretful, we have added substance abuse counselors in our emergency department," he says. "If you're 50 years old and you wind up in the emergency room because you drink too much, then you have a problem. So, we recognize our opportunity to intervene and do the general population some good by trying to get them the help they need."

Atallah says the rise in alcohol-related ER visits is challenge, but it’s been manageable.

"We work in the emergency department. We see 146,500 visits a year. We manage the unmanageable every day, simply because of the volume," he says. "Emergency departments across the country have seen increasing volumes over the past several years and decades. This patient population volume based on the study has also increased and has added to that stressed emergency department capacity for the country. So, it's certainly contributed. I don't think that those patients in particular have made emergency department care as challenging as it is today but it certainly has contributed."

One strategy at Grady has been to "cohort" drunk patients into specific areas of the ER and provide appropriate levels of resources.

"Someone who is waiting to sober up doesn't need four-to-one nursing. It can be eight- or 10-to-one," Atallah says. "We have high volumes of very sick patients coming in. Those patients are in rooms. We have an ambulance triage area, and as long as the person who is intoxicated isn’t unruly we can let them hang out there and sober up and then we see them. That doesn’t necessarily require intensive monitoring. With as crowded as emergency departments are now, you don’t want them taking up valuable resource and real estate. You try the best you can to find the right place to take care of them."

John Commins is a senior editor at HealthLeaders.

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