Authors' objectives: Drunkenness is a common night-time problem in many UK towns and cities and intoxicated patients are at risk of choking, injury, unconsciousness and death. Traditionally, the very drunk have either been escorted to a hospital Accident and Emergency (A&E) so that their health can be monitored or drunken offenders went into police custody. Recently the police issued guidance for all UK forces stating that those who are drunk cannot be housed in custody due to possible health complications, unless a clinical decision maker determines that it is safe to do so. A&E is one of the few clinical services available in the evening and this is where most of those who need clinical input end up. This places additional demand on overstretched emergency services at a time when they are experiencing unprecedented levels of demand. Ambulances have to wait longer in order to hand over patients to A&E staff because clinical staff are busy elsewhere, police officers (accompanying drunk offenders to A&E) are delayed, taking them away from their duties in the city centre, and other patients in A&E may wait longer to receive clinical attention. These delays mean there are fewer police officers on patrol deterring violence and fewer ambulances available to respond to emergency calls. In addition, the behaviour of drunk patients is often disorderly, they lose control of their body and therefore vomit and defecate uncontrollably. This affects the A&E environment, waiting rooms and other patients, including children, can become distressed. Welfare Centres, Safe Havens and Alcohol Treatment Centres are services that provide a safe environment in which drunk people can be assessed, treated in some, monitored or referred to A&E. They are usually developed through partnerships that including local government, police, healthcare and other agencies that are all affected by the problem of drunkenness. The primary goal is usually to safely divert as many drunks as possible from A&E into centres to improve the provision of care in A&E, provide a facilities where police, ambulance and others can quickly hand over drunks to clinical staff and therefore improve patient experiences of care in unscheduled care. We plan to evaluate the effectiveness and cost effectiveness of centres in meeting these goals and to understand the broader impact on the working lives of staff, including stress and morale. A mixed methods evaluation will be conducted. This includes an ethnographic study where researchers shadow practitioners to understand how they work in the context of managing drunks, a survey of patients to understand how Alcohol Treatment Centres improve patient experiences in A&E together with interviews with patients and staff, the analysis of routine data and simulation modelling to understand any impact on key performance indicators in health, police and ambulance services. Outputs from the research will be of broad relevance to decision makers and will include journal articles, presentations at conferences and a model for further service development that will likely be of considerable interest across the UK and internationally (while similar services exist across Europe, Australia and North America none have been formally evaluated). A primary goal of this project is the provision of evidence that is useful for practitioners involved with managing night time environments.

Project Status: Completed

URL for project: http://www.nets.nihr.ac.uk/projects/hsdr/140425

Year Published: 2020

URL for published report: http://www.nets.nihr.ac.uk/projects/hsdr/140425

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Services and Delivery Research programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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