Improving detection of alcohol misuse in patients presenting to an accident and emergency department

Objectives-To assess and improve deployment of a brief test for alcohol mis use: the Paddington Alcohol Test (PAT). Design-Prospective study of the effects of audit feedback. Setting-An urban accident and emergency department. Subjects-Senior house officers (SHO) (n=13). Outcome measurements-PAT use and categorisation of patients for each SHO; o bservational analysis of presenting complaints according to PAT. Results-1062 of 1737 patients (61.1%) were defined as PAT possible-that is, presented with greater than or equal to one complaint listed on the PAT te st proforma. In month 1, PAT uptake was poor. PAT use improved significantl y when feedback was instituted (p>0.0001). The response to audit and feedba ck showed marked inter-SHO variation. When feedback was withdrawn (month 4) ,there was a significant reduction in PAT use (p=0.003). Three other indice s of detection followed this trend: (a) number of PAT positive patients ide ntified, (b) proportion of PAT possible patients identified as PAT positive , and (c) number of PAT positive patients referred to the alcoholic health worker. The 10 most common PAT positive categories, accounting for 77% of a ll PAT positive complaints were: fall > collapse (including "fit", "blackou t") > head injury (including "facial injury") > assault (including "domesti c violence" and 'other') > nonspecific gastrointestinal problem > "unwell" > psychiatric (including "depression", "overdose", "confusion") > cardiac ( including "chest pain" and "palpitations") > self neglect > repeat attendan ce. Conclusions-Ongoing audit with feedback improves both PAT use and detection of alcohol misuse. The PAT is now simpler including only 10 conditions, wh ich should further aid its use.