Improving detection of alcohol misuse in patients presenting to an accident and emergency department

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Abstract
Objectives—To assess and improve deployment of a brief test for alcohol misuse: the Paddington Alcohol Test (PAT). Design—Prospective study of the effects of audit feedback. Setting—An urban accident and emergency department. Subjects—Senior house officers (SHO) (n = 13). Outcome measurements—PAT use and categorisation of patients for each SHO; observational analysis of presenting complaints according to PAT. Results—1062 of 1737 patients (61.1%) were defined as PAT possible—that is, presented with ≥ one complaint listed on the PAT test proforma. In month 1, PAT uptake was poor. PAT use improved significantly when feedback was instituted (p collapse (including “fit”, “blackout”) > head injury (including “facial injury”) > assault (including “domestic violence” and `other') > non-specific gastrointestinal problem > “unwell” > psychiatric (including “depression”, “overdose”, “confusion”) > cardiac (including “chest pain” and “palpitations”) > self neglect > repeat attendance. Conclusions—Ongoing audit with feedback improves both PAT use and detection of alcohol misuse. The PAT is now simpler including only 10 conditions, which should further aid its use.