Who Needs Inpatient Detox? Development and Implementation of a Hospitalist Protocol for the Evaluation of Patients for Alcohol Detoxification

A Capsule Commentary to this article was published on 22 January 2014

ABSTRACT

BACKGROUND

Clinicians caring for patients seeking alcohol detoxification face many challenges, including lack of evidence-based guidelines for treatment and high recidivism rates.

OBJECTIVES

To develop a standardized protocol for determining which alcohol dependent patients seeking detoxification need inpatient versus outpatient treatment, and to study the protocol’s implementation.

DESIGN

Review of best evidence by ad hoc task force and subsequent creation of standardized protocol. Prospective observational evaluation of initial protocol implementation.

PARTICIPANTS

Patients presenting for alcohol detoxification.

INTERVENTION

Development and implementation of a protocol for evaluation and treatment of patients requesting alcohol detoxification.

MAIN MEASURES

Number of admissions per month with primary alcohol related diagnosis (DRG), 30-day readmission rate, and length of stay, all measured before and after protocol implementation.

RESULTS

We identified one randomized clinical trial and three cohort studies to inform the choice of inpatient versus outpatient detoxification, along with one prior protocol in this population, and combined that data with clinical experience to create an institutional protocol. After implementation, the average number of alcohol related admissions was 15.9 per month, compared with 18.9 per month before implementation (p = 0.037). There was no difference in readmission rate or length of stay.

CONCLUSIONS

Creation and utilization of a protocol led to standardization of care for patients requesting detoxification from alcohol. Initial evaluation of protocol implementation showed a decrease in number of admissions.

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Acknowledgements

Preliminary results from the project described in this manuscript were presented as a poster at the annual meeting of Society of Hospital Medicine in April 2012 and at the annual meeting of Society of General Internal Medicine in April 2012.

No authors have received any monetary support for work related to this project.

Conflicts of Interest

The authors declare that they do not have a conflict of interest.

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Correspondence to John R. Stephens MD.

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Stephens, J.R., Liles, E.A., Dancel, R. et al. Who Needs Inpatient Detox? Development and Implementation of a Hospitalist Protocol for the Evaluation of Patients for Alcohol Detoxification. J GEN INTERN MED 29, 587–593 (2014). https://doi.org/10.1007/s11606-013-2751-3

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KEY WORDS

  • alcohol detoxification
  • alcohol withdrawal
  • quality improvement
  • hospital medicine