D Allen, P Meier, A Brennan, S Goodacre, A O’Cathain, V Sivarajasingam, J Shepherd, T Young, A Irving, P Buykx
|Welfare Centres, Safe Havens and Alcohol Treatment Centres are designed to receive intoxicated patients who would normally attend Emergency Departments (ED), to lessen the burden that alcohol-misuse, an avoidable healthcare cost, places on unscheduled care and care for those who have become vulnerable. They are typically located close to areas characterised by excessive intoxication and are open at times when levels of intoxication peak. They therefore offer the potential to mitigate some of the pressures on ED at times when they are experiencing a sustained increase in demand. The need to reduce pressure in ED is clear. Most admissions to ED are alcohol-related at peak times and they cause the ED clinical environment to suffer, as well as staff morale. Staff become stressed causing a detriment to care, and patients can become aggressive or fearful.|
This project aims to estimate the effectiveness, cost-effectiveness, efficiency and acceptability of centres in managing alcohol-related ED attendances. The proposed evaluation method, organised into three work streams (WS), is that of a natural experiment, comparing areas in which centres have been implemented or are planned to control cities matched using Home Office iQuanta similar families. Mixed methods are used to address specific research questions. WS1 will use ethnographic studies; interviews with stakeholders, policy makers and practitioners; interviews with patients attending centres and surveys of ED and centre users. In WS2, routine data will be analysed to quantify the effect of centres in respect of key performance indicators and, in WS3, an economic evaluation will consider the cost of centre implementation. WS1 will consider the impact of centres on working practices of front-line professionals in the emergency care system, with particular reference to well-being. Interviews with centre users will inform the development of a survey for this group to assess the acceptability of centres. Surveys will assess the impact of centres on ED users’ perceptions of the ED environment, compared to control EDs where there is no centre implementation. The inter-agency relationships between the police, health, ambulance and the broader community, required for successful implementation, including opportunities for shared funding, will be scrutinised. WS2 will assess any improvements to effectiveness across partners (e.g. ambulance handover times, patient episode duration in ED, police resource effectiveness measured through a reduction in city centre violence) and explore whether the effects of improved capacity (e.g. fewer police and ambulance resources in ED bottlenecks) due to centre provision impacts on community safety and therefore alcohol-related violence. In WS3 we will ask ‘what are the costs of setting up and running a centre, and what cost savings may be realised elsewhere?’
In addition, the project will seek to capture the variability that exists in night time economy provision for managing the intoxicated. The research will inform local and national decision makers on opportunities for a national roll-out across UK cities and will share what is known about what works through the study of effectiveness, efficiency, processes, barriers and opportunities.
For more information on the project, please click the following link.