Background

In January 2022, Ireland introduced minimum unit pricing (MUP) at EUR 1.00 per 10 grams of alcohol as per Section 11 of the Public Health (Alcohol) Act 2018.1 The Act was introduced in response to the high level of alcohol use and related harms in Ireland. Alcohol-related hospital discharges are collected through the Hospital In-Patient Enquiry (HIPE) Scheme; however, the burden of alcohol-related harm in emergency departments (ED) in Ireland is largely unknown, as this information is not routinely collected.2 One study in 2018 estimated that 6% of ED presentations are alcohol related.3 A study by Maharaj et al. in 2024 sought to determine the impact of alcohol on ED presentations and hospital admissions and to investigate if the introduction of MUP impacted such presentations or admissions.4

Methods

The study author was stationed in the ED of Beaumont Hospital, Dublin for two periods: one before the commencement of MUP (November–December 2021) and again following the commencement of MUP (February, March, and April 2022). Interviews with those who presented to ED were carried out and included a brief clinical history and type of alcohol usually consumed, and the Alcohol Use Disorders Identification Test-Concise (AUDIT-C) was administrated to determine drinking patterns of patients.5

Results

In period 1, some 364 patients were interviewed, while 361 patients were interviewed in period 2. Alcohol-related presentations accounted for 19.4% of all ED presentations. Males accounted for 63.1% of alcohol-related presentations compared with 36.9% of females; those aged 40–50 years were more associated with alcohol-related ED presentations compared with other age groups.

The median AUDIT-C score for alcohol-related presentations was 9 (3 for overall sample). Wholly alcohol-attributable presentations were more common on Thursdays and Saturdays and the most common purpose of the ED visit was for acute injuries (32.6%), chest complaints (19.1%), and mental health queries (16.3%). Beer was the beverage preferred by 40.5% of the sample and wine by 24.0%.

In period 1, some 22.8% of ED presentations were alcohol related, while in period 2, it had reduced to 16.1%. However, acute wholly alcohol-related presentations increased by 19.8% between periods 1 and 2. Of all admissions to hospital, 17.3% were alcohol related (3.1% wholly alcohol-attributable); the number decreased between period 1 (19.7%) and period 2 (14.0%), although this decrease was not statistically significant.

Discussion

This study demonstrates the extent of the burden that alcohol places on Beaumont Hospital. Although the study found a significant reduction in alcohol-related ED presentations following the commencement of MUP, alcohol-related hospital admissions did not decrease. The authors recommend the instruction of cost-effective alcohol care teams (ACTs) in Irish hospitals to reduce alcohol-related ED presentations, hospital admissions, and mortality.

1    Office of the Attorney General (2018) Public Health (Alcohol) Act 2018. Dublin: Irish Statute Book. Available from: https://www.drugsandalcohol.ie/33698/

2    Healthcare Pricing Office (2004) Hospital In-Patient Enquiry (HIPE) Scheme. Dublin: Health Service Executive. Available from: https://www.hpo.ie/

3    McNicholl B, Goggin D and O’Donovan D (2018) Alcohol-related presentations to emergency departments in Ireland: a descriptive prevalence study. BMJ Open, 8: e021932. Available from: https://www.drugsandalcohol.ie/29070/

4    Maharaj T, Fitzgerald N, Gilligan E, Quirke M, MacHale S and Ryan JD (2024) Alcohol-related emergency department presentations and hospital admissions around the time of minimum unit pricing in Ireland. Public Health, 227: 38–41. Available from: https://www.drugsandalcohol.ie/40186/

5    Babor TF, Higgins-Biddle JC, Saunders JB and Monteiro MG (2001) AUDIT: The Alcohol Use Disorders Identification Test – guidelines for use in primary care. 2nd edn. Geneva: Department of Mental Health and Substance Abuse, World Health Organization. Available from: https://www.drugsandalcohol.ie/14104/