Screening and Recording of Patients' Alcohol-use Habit by Clinicians in a Tertiary Accident and Emergency Unit in Ireland.

BACKGROUND: Alcohol is widely consumed in Ireland; more so in major urban centers. Alcohol-related problems account for a significant number of Accident and Emergency (A and E) department presentations in Ireland. As a result, the national alcohol policy calls on doctors to be proactive in screening for and addressing alcohol misuse. AIM: The aim of the following study is to determine if patients presenting to a tertiary North Dublin A and E were asked about their alcohol use habit and if it was recorded. MATERIALS AND METHODS: This was a descriptive observational study involving the retrospective review of case-notes for all patients who were assessed at the A and E Department of a North Dublin general hospital over a 1 week period for screening about their alcohol use habit. Data was entered into and analyzed using Microsoft Excel. RESULTS: Only 17% (106/613) of the A and E attendees over the study period were asked about their alcohol use habit or had it recorded. No case-note examined documented use of alcohol screening instruments. CONCLUSION: This study has revealed an inadequacy of enquiry about alcohol use habit. In light of high rates of alcohol misuse in Ireland we suggest the need for improved enquiry/screening and recording of alcohol use among all patients attending A and E's.

The additional impact of liaison psychiatry on the future funding of general hospital services.

Accurate coding system is fundamental in determining Casemix, which is likely to become a major determinant of future funding of health care services. Our aim was to determine whether the Hospital Inpatient Enquiry (HIPE) system assigned codes for psychiatric disorders were accurate and reflective of Liaison psychiatric input into patients' care. The HIPE system's coding for psychiatric disorders were compared with psychiatrists' coding for the same patients over a prospective 6 months period, using ICD-10 diagnostic criteria. A total of 262 cases were reviewed of which 135 (51%) were male and 127 (49%) were female. The mean age was 49 years, ranging from 16 years to 87 years (SD 17.3). Our findings show a significant disparity between HIPE and psychiatrists' coding. Only 94 (36%) of the HIPE coded cases were compatible with the psychiatrists' coding. The commonest cause of incompatibility was the coding personnel's failure to code for a psychiatric disorder in the present of one 117 (69.9%), others were coding for a different diagnosis 36 (21%), coding for a psychiatric disorder in the absent of one 11 (6.6%), different sub-type and others 2 (1.2%) respectively. HIPE data coded depression 30 (11.5%) as the commonest diagnosis and general examination 1 (0.4%) as least but failed to code for dementia, illicit drug use and somatoform disorder despite their being coded for by the psychiatrists. In contrast, the psychiatrists coded delirium 46 (18%) and dementia 1 (0.4%) as the commonest and the least diagnosed disorders respectively. Given the marked increase in case complexity associated with psychiatric co-morbidities, future funding streams are at risk of inadequate payment for services rendered.