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UNC Develops First Flowchart for Alcohol-related Hospital Admissions


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By Stephanie Soucheray

Alcohol-related hospitalizations can cost about $5.1 billion annually in health care spending. Considering that alcohol consumption is the third-highest cause of preventable death in the United States, that number isn’t surprising.

But it is high for a condition for which hospital admittance protocols aren’t agreed upon by institutions, doctors or nurses.

“Some of us would admit these patients, while some of us would send them home,” said John Stephens.

Stephens, a professor of medicine at UNC-Chapel Hill, recently published a new protocol – a medical flowchart, if you will – that helps standardize the approach to hospital admissions of alcohol-related diagnoses.

“This population had a subset with a lot of readmissions,” he said. “Many would get better, we’d send them home and then they’d be readmitted in the same month.”

Stephens said that a protocol could potentially help admit fewer of these people into the hospital, which would cut down on the “excessive utilization of resources.” In other words, admitting fewer patients and guiding them towards outpatient care can save hospitals a lot of money.

In order to create the one-page flowchart for physician use, Stephens created a task force with three doctors, a nurse practitioner and a case manager at UNC Hospitals. The group met several times to look at the medical literature on alcohol-related diagnoses before crafting their recommendations.

The protocol and the results of an 18-month follow-up on its implementation at UNC Hospitals show some promising trends: alcohol-related admissions per month dropped from about 19 to 16 patients. According to the study, that translates into a cost savings of $315,000 per year.

Stephens said the flowchart, however, did little to influence re-admittance rates.

“The best thing from our perspective is that we can standardize care,” he said. “When we’re called into the ER, then we can say, ‘We need to use this approach.’”

Stephens said the flowchart is part of a broader trend in medicine partially based on The Checklist Manifesto by Atul Gawande. Gawande’s book argues for the use of flowcharts and checklists to help medical professionals streamline decision-making.

UNC Alcohol detox protocol and checklist.

UNC Alcohol detox protocol and checklist. Image courtesy: UNC Healthcare

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