Binge Drinking Patients and Effects on Staff - Literature review Example

Binge drinking, what are the effects on the emergency department and the impact on diagnostic radiography Literature Review Numerous studies to have studied the size of problem of the consumption of alcohol over the last 30 years as well as its impact on the services provided in the emergency departments (Pirmohamed et al, 2000; Charalambous, 2002). Alcohol problems are frequently experienced in the attendees of Accident and Emergency (A&E) departments (D’Onofrio and Degutis, 2005, p. 63). About 2 to 40 per cent of all A&E attendances can be attributed to problems related to alcohol while the relative proportion depends upon the hospital’s location, the target population mixture, and the investigative technique involved (Charalambous, 2002). Although the A&E attendances caused because of alcohol consumption may occur any time throughout the day, yet most of them happen during weekends and at nights when the tendency of people to consume alcohol is maximal (Pirmohamed et al., 2000). The male attendances outnumber the female attendances by more than twice and most of these attendees are young adults lesser than 40 years of age, which suggests that a vast majority of binge drinkers are young adults (Pirmohamed et al., 2000). The tendency of being involved in the alcohol-related violence in men is twice as much as that in women. 50 per cent of the injuries are related to neck and head and almost 25 per cent of the victims are hospitalized (Wright and Kariya, 1997). Binge drinking is one of the main causes of physical violence and verbal abuse of the healthcare professionals serving in the A&E departments. The effects of patients with the effects of binge drinking appearing in the A&E departments on the staff have been measured in different countries and most of the research studies have invariably estimated high level of danger and risks for the staff. In Australia, 2.3 per cent of the overall burden of disease could be attributed to alcohol in the year 2003 that was equivalent to 61091 life years adjusted for disability (Harvard et al., 2011). The burden of harm caused by binge drinking in Australia has been found to be disproportionately high in the rural areas as compared to the urban areas. Departments that are usually affected the most are the inner city departments and the healthcare professionals assuming the maximal risk of assaults are nurses and male doctors. The healthcare providers in general and the staff at the emergency departments in particular have many concerns of safety while dealing with the binge drinkers. One of the nurses interviewed by Gunasekara et al. (2011) expressed these concerns in these words, “I have no hesitation in calling police, just cos [because] theyre drunk. If you assess someone and they’re breathing, talking, yelling, and going to physically hurt you, then theyre probably just as safe in a police cell as they are waiting in the emergency department. As much as they have a right to be treated, we have a right to be safe in our work environment” (Gunasekara et al., 2011, p. 18). Patterns of excessive consumption of alcohol reflect in the statistics of casualty in hospitals as well as in the data of hospital emergency rooms. The self-reported consumption of alcohol in the period of six hours from the time of admission in the hospitals is higher among the attendees that are injured as compared to the uninjured attendees. The rate of attendance at the night time is higher as compared to day-time attendance and between 20 and 40 per cent of the cases of emergency attendance are intoxicated (Institute of Alcohol Studies, n.d., p. 5). Patients appearing in the A&E departments most commonly come with a physical examination that suggests rupture of urinary bladder have experienced a traumatic event previously (Daignault, Saul, and Lewiss, 2012, p. 1). Although the spontaneous atraumatic rupture of bladder is not very common, yet it may happen in the context of binge drinking. Patients intoxicated by binge drinking pose numerous therapeutic and diagnostic challenges to the physicians in the A&E departments that have to take on the additional urgency because of the high tendency of the unrecognized bladder rupture to cause mortality. It is imperative that the healthcare professionals providing patients in acute alcohol withdrawal with care are skilled in the assessment as well as supervision of the signs and symptoms of withdrawal (NICE clinical guideline, 2010, p. 7). According to Daignault, Saul, and Lewiss (2012), it is recommendable for the emergency physicians to consider the rupture of bladder during the binge drinkers’ initial evaluation with the nonspecific abdominal pain in recent alcohol intoxication’s context. A&E departments in the health system are generally well placed to play a very important role in the reduction of harm caused by alcohol. Nevertheless, there is need to overcome the attitudinal and structural barriers to the use of A&E departments for screening as well as to deliver the brief anti-alcoholic interventions. The A&E staff needs to adopt a holistic approach to manage the binge drinkers effectively. This holistic approach needs to be based on three levels of patient care that are equally important. These three levels include management of acute health problem that became the cause of attendance of the A&E department by the binge drinkers, the possible mental or physical chronic health problems caused by binge drinking, and all sorts of possible drinking problems (Charalambous, 2002) as illustrated in Fig. 1. Fig. 1: Prolems caused by alcohol and their management by A&E departments (Charalambous, 2002). Gunasekara et al. (2011) studied the effect of intoxicated patients on the staff members in the emergency department and found the verbal assault rates from the patients affected by alcohol to be high especially among the nurses. Alcohol-related presentations negatively affect the mood of the staff and increases their perceptions of the workload. Staff members had mixed views about effect of the quality of care on the intoxicated patients while most of them thought that the care had negative effect on other patients. “This small exploratory study found that alcohol-related presentations have a negative impact on ED staff workload and safety, and may compromise treatment of all patients” (Gunasekara et al. 2011, p. 14). The researchers said more research needs to be carried out to corroborate the findings of the research as well as to study the policies required to alleviate the effect of presentations related to alcohol in the emergency department. More than 85 per cent of the staff in the emergency department said that lack of patient motivation posed difficulty in the making of alcohol interventions (Indig et al., 2009, p. 23). The staff members at the A&E departments do not only have to deal with the fear of being physically assaulted by the binge drinkers, but also have many emotional challenges to deal with. These emotional challenges are posed by the thought that they are dealing with an individual who has caused harm to others because of the habit of binge drinking. On one hand, the healthcare providers are morally obliged to provide unbiased and high quality treatment to the binge drinkers in spite of all reasons, and on the other hand, they are being constantly frustrated by the high tendency of these individuals to cause them harm. One of the staff members interviewed by Gunasekara et al (2011) said, “Morally we have to be completely objective in our level of care, but it can be hard if you know that the person you are treating has killed two other people just because they did this drink driving thing. That can again cause increased frustration for staff” (Gunasekara et al., 2011, p. 18). It is often hard for the staff members at the A&E departments to suppress the feelings of aggression and frustration toward the binge drinker attendees for the same reasons. The panic caused by the behavior and condition of the binge drinkers increases the tendency of the staff members to make uninformed decisions in the A&E departments. Since the year 2000, the radiologists have found a consistent increase in the CT head scans’ demand from the A&E department at the tertiary hospital (Rodriguez and Pehlps, 2007). A large number of these demands of CT head scans are deemed inappropriate by the radiologists (Rodriguez and Bilbault, 2009, p. 151). “There may be no significant correlation between alcohol consumption and injury severity. However, injury severity may increase with increasing quantity of alcohol and be greater in head injuries” (Choi et al., 2009, p. 956). Boldy, Yates, and Ong (2010) determined the attitudes, knowledge, and behavior of the technologists of medical imaging about alcohol in Western Australia. The researchers devised specific questions about alcohol, its size and content, and its effect of behavior. The responses gained from 91 medical imaging technologists led to the conclusion that they knew much about alcohol related facts, though this knowledge did not always reinforce appropriate behavior and attitudes about dealing with the alcohol abuse. Some trends were apparent despite lack of statistically significant differences based on age group, sex, and location. The research led to the conclusion that medical imaging technologists are presently not equipped enough to form part of education’s health promotion model. One limitation found from the study of Boldy, Yates, and Ong (2010) is that the results of injuries, disease, and accidents caused by the alcohol abuse are frequently seen by the health professionals, but there is dearth of research about their role in relation to the promotion of health. More research needs to be conducted to study the attitudes, knowledge, and behavior of the medical imaging technologists about the abuse of alcohol as well as the level to which they are prepared to play a constructive role in the promotion of health. King and Schofield (2005) suggest that healthcare providers should start the treatment of trauma patients by first assessing their level of consciousness. The top priority is to protect the airway because the intoxicated patients assume the risk of vomiting since the alcohol irritates the stomach and also has the tendency to trigger emetic center in the brain. Vomiting can cause aspiration. Healthcare providers should also monitor the intoxicated patients for hypokalemia and hypomagnesemia that are related to alcohol abuse and can cause cardiac arrhythmias. Patients’ nutritional status should be assessed by lab tests. Alcohol withdrawal syndrome can take anywhere from 24 hours to 14 days to develop (King and Schofield, 2005). The patient needs supervision for possible effects of binge drinking that include but are not limited to restlessness, tremor, agitation, and dehydration. Postoperative care can be difficult to provide because of alcohol withdrawal syndrome that produces metabolic responses and hyperdynamic cardiovascular responses. The patient is susceptible to developing such cardiovascular complications as myocardial infarction. Patients that develop alcohol withdrawal syndrome need frequent monitoring of their signs and assessment of their neurologic, cardiovascular, and respiratory status. Healthcare providers need to administer benzodiazepine to treat the symptoms of benzodiazepine. The patient needs frequent reorientation to place, time, and person. Before discharging the patient, the healthcare provider needs to inform the patient as well as the family members regarding the resources of substance abuse that are available to them. Gill and O’May (2011) carried out research to study the perceptions and knowledge about the role of nursing and allied health professional students in alcohol misuse. Research led them to the conclusion that there are grey areas in the knowledge about the current UK health guidelines in general and in the nursing and allied health professional students in particular. Gill and O’May (2011) identified three broad student groups in this area of practice; the first group is of students that know their role clearly e.g. the nursing and medical students, the second group is of students that advocate a role that the fellow students do not identify e.g. the pharmacy and occupational therapy students, while the third group is of students that do not know their role with certainty e.g. the speech and language therapists, radiographers, and physiotherapy students. The responsibility is partly shared by the higher education institutions also as they need to address the gaps in knowledge about guidance in the consumption of alcohol. The brief interventions’ effectiveness depends on this guidance. In addition to that, the contribution of practitioners to this clinical role can be enhanced through collaboration with the professional bodies and inter-professional teaching. The growth in use of diagnostic imaging has a significant effect on the cost and quality of healthcare services. Although there are a variety of modifiable factors for the unnecessary availability of the radiological services, yet there is not much awareness about their relative impact (Lysdahl and Hofmann, 2009, p. 1). The healthcare costs are significantly impacted by the expansion of the radiological services (Otero et al., 2006). This expansion also affects the quality of healthcare services which is why the risk of exposure to radiation has gained a lot of attention recently (NCRP, 2009). The role of radiologists in promoting such knowledge is very important. Lysdahl and Hofmann (2009) carried out a research to investigate the perspectives of radiologists about the causes of unnecessary use and increase in the radiological investigations. They used a five-point scale to ask the perceptions of the radiologist members of the Norwegian Medical Association regarding the causes of unnecessary investigations and increased volume of investigation. Their research led them to the conclusion that the highest rated causes of increase in the availability of investigations of radiology are people’s demands, new radiological technology, availability, expanded clinical indications, and intolerance of the clinicians for uncertainty. “In order to manage the growth in radiological imaging and curtail inappropriate investigations, the study findings point to measures that influence the supply and demand of services, specifically to support the decision-making process of physicians” (Lysdahl and Hofmann, 2009, p. 1). (Roudsari et al. (2012) evaluated the burden posed by injuries related to alcohol on the department of radiology and found that higher concentration of alcohol in the blood was related to increased CT utilization for most of the regions in the bodies of the binge drinkers and the association between higher concentration of alcohol in blood and increased CT utilization was stronger in patients whose injuries were less severe. Roudsari et al. (2012) declared all such guidelines that can bring substantial reduction in the unnecessary imaging for the patients suffering from injuries related to alcohol as representative of a cost-saving strategy. There has been very little research on the way binge drinkers impact the staff members in the radiology department in specific. “To our knowledge, no earlier study has quantified the burden of alcohol-related injuries on radiology services. Consequently, no study has designed a protocol that could potentially minimize such a burden” (Roudsari et al., 2012). Binge drinking not only has many negative implications on the health of the binge drinkers, but it also has many negative social consequences, some of which are experienced by the professionals in the A&E departments that are responsible for providing these attendees with immediate care and help. In a vast majority of cases, dealing with the intoxicated attendees is physically as well as emotionally challenging for the staff members at the A&E departments. In order to provide these attendees with care without delay or experiencing negative effects, it is imperative that healthcare centers and hospitals are well-equipped and have a well-documented plan that details the procedure of dealing with these attendees. A&E departments in the health system are well placed to play a crucial role in reducing the harm caused by binge drinking. The functionality of the A&E departments has conventionally mostly been limited to effective management of the emergency complaints related to the binge drinkers. Most A&E departments do not recognize or provide effective management of the underlying drinking problems. Different studies to date have elaborated that screening the problem drinking and responding to it positively in the A&E settings is possible, though there are attitudinal and structural barriers in the achievement of this objective by the A&E departments. The structure of A&E departments’ organization as well as the nature of the healthcare provided poses complications for the staff members that need to respond to the preventive activities. Time needed for the screening of patients for binge drinking is the major factor. Factors that predict good self-reported practice of the staff of the A&E departments include but are not limited to being confident, being a doctor, and being responsible about the management of binge drinkers. In addition to that, in order to make the process of providing binge drinkers with care in the A&E departments, it is essential for the health departments to issue guidelines for the healthcare professionals. 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