Assessment of a modified MINDS-based protocol for management of alcohol withdrawal syndrome on an inpatient medical service.

OBJECTIVE: To determine if a novel symptom-based alcohol withdrawal syndrome (AWS) protocol in a US Veterans cohort leads to significant clinical improvements in patient outcomes and safety. BACKGROUND: Prior studies of AWS management, oftentimes using the revised version of the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) index, have demonstrated the effectiveness of symptom-triggered therapy for AWS. The Minnesota Detoxification Scale (MINDS) is an alternative to the CIWA-Ar index but remains unevaluated outside of the intensive care unit (ICU) setting. This study assesses outcomes in AWS management prior to and after the implementation of a novel MINDS-based AWS protocol (SDAWP) utilizing a revised MINDS index (MINDS-rev) in an inpatient medical ward setting. METHODS: Retrospective cohort study including encounters prior to (n = 342) and after (n = 338) the implementation of the protocol. Pre- and post-protocol encounters were selected by combinations of diagnostic codes and charting elements. Outcome measures of AWS management were obtained in both groups. The primary endpoint was median total benzodiazepine exposure. Secondary outcomes included median length of hospitalization, median duration of benzodiazepine administration, and the incidence of complications. RESULTS: The median total benzodiazepine exposure in the post-SDAWP group was significantly lower than the pre-SDAWP group (21.2 vs. 12.0 mg, p < 0.0001) and for a significantly shorter median duration of time (4.0 vs. 3.0 days, p < 0.0001). There was no significant difference in the median length of stay (4.0 vs. 4.0 days, p = 0.50). The incidence of delirium tremens (21 vs. 7, p = 0.01) and need for transfer to a higher level of care (33 vs. 12, p = 0.002) was significantly lower in the post-SDAWP group. CONCLUSION: The SDAWP has provided significant improvements in AWS management in our institution and may potentially serve as a template for wider use in other inpatient settings.

"Windshield Tour" - A Journey Towards Cultural Competency.

PURPOSE: Medical educators are directing greater attention to the promotion of cultural competency when prioritizing educational program goals. An innovative educational approach is described here in a community hospital where nearly one-third of its citizens fall below the poverty level. The intent was to provide a very personal, first-hand learning experience via witnessing living conditions of patients from poverty-stricken neighborhoods. METHOD: Hospital educators worked with the community organization FACED (Faith Access to Community Economic Development). This grassroots group developed an educational driving excursion - entitled the "Windshield Tour" - of the city hospital's poorest areas. A knowledge/attitude questionnaire was administered as a pre- and post-test to 80 residents and medical students. RESULTS: Significant changes were observed in participants' understanding of personal/financial hardships faced by their patients, perceptions of availability of resources, understanding of issues related to health care benefits, and rankings of patient/physician characteristics deemed important. CONCLUSION: Hospital educators have met with FACED leaders to explore future collaborative projects that would increase exposure to the community for the residents and students.