Background

In 2022, there were 17,512 discharges from Irish hospitals for wholly alcohol-related diagnoses, according to the Hospital In-Patient Enquiry (HIPE) scheme, indicating that alcohol is a common reason for hospital admission.1 The mean length of stay for alcohol-related hospitalisations nationally is 9.9 days, increasing from 6.1 days in 2001, and almost double that of non-alcohol-related conditions (5.7 days), and representing 5.2% of all inpatient bed days.2 This does not include emergency department (ED) presentations as they are not routinely collected in Ireland. However, a study carried out in Beaumont Hospital in Dublin found that 19.4% of ED presentations were alcohol-related.3

Alcohol-related hospitalisations only account for some of the societal costs of alcohol harm in Ireland. A 2021 systematic review estimated the costs in high income countries such as Ireland to be 2.6% of gross domestic product, the equivalent of approximately EUR 12 billion.4 Alcohol use places a considerable burden on Ireland’s healthcare system and alcohol liaison specialist nurses play a crucial role within a hospital environment in supporting patients to address their harmful drinking patterns or alcohol dependence. The ultimate aim of the service is to reduce repeat admissions to hospital due to alcohol and consequently reduce the resource burden (both financially and staffing) on the hospital as well as help the patient to manage their alcohol use, promoting a healthier lifestyle, physically and mentally.

Role of alcohol liaison nurse

The alcohol liaison nurse (ALN) is part of a multidisciplinary team engaging with inpatients with alcohol-related health problems. The role includes conducting comprehensive assessments to understand the patient’s alcohol use history, physical and mental health, and social circumstances to determine the severity of the problem and inform treatment plans. The ALN provides specialist advice and guidance to the patient in the form of brief interventions, which are delivered to patients to help address their alcohol use and/or consider treatment options. The ALN may provide pharmacology for safe detoxification; vitamin therapy; alcohol education and training to other hospital staff; and onward referral to support services.

Alcohol Liaison Service, Beaumont Hospital, 2023

The Beaumont Alcohol Care Initiative is a cross-disciplinary group set up to tackle the issue of alcohol in Beaumont Hospital and within its catchment area. Clinical nurse manager (CNM2) Elizabeth Gilligan is an ALN on the team, in post since 2008. In 2008, when working part-time, 175 inpatients with alcohol problems were referred to her. In 2023, this had increased to 781 inpatient referrals, representing a 346% increase in the 15-year period and the highest number of referrals recorded since the creation of the post. Some 139 (17.8%) inpatients referred were not seen due to resource constraints. Of the referrals, 642 inpatients were reviewed a minimum of four times during their hospital stay, ensuring a rapport was developed and a detox regime supervised, where applicable.

Referred patients were provided with an assessment and individual counselling for their alcohol use, and those willing to engage were referred to an appropriate addiction service available in their area of residence. This includes local services, such as Áit Linn outreach service in Ballymun, Dublin (closed since April 2024), and the North Dublin and Ballymun Drug and Alcohol Task Force, as vital interventions following hospital discharge for both patients and their families. Patients outside the Dublin area are referred to their local taskforce teams via a network of services. Patients from ethnic minorities and non-English-speaking patients are linked with appropriate services, wherever available.

The ALN does not have the capacity to cover the ED, despite the recognised need. However, patients with an urgent requirement are seen wherever possible.

Conclusion

There is evidence that the provision of hospital-based-specialist ALN services can reduce hospital readmissions and improve patient outcomes.5,6 Many patients referred to the ALN have never approached their general practitioner (GP) or any alcohol service for help. Many are unaware of the harm caused by alcohol use or the impact their drinking has on their family members.

Brief interventions in a hospital setting are relatively inexpensive, but can achieve health gains for the population as well as potential cost savings for the hospital by reducing readmissions.7

 
1    Doyle A (2023) Regional alcohol-related harm: county level factsheet. Dublin: Health Research Board. Available from: https://www.drugsandalcohol.ie/39285/

2    Doyle A, Mongan D and Galvin B (2024) Alcohol: availability, affordability, related harm, and policy in Ireland. HRB Overview Series 13. Dublin: Health Research Board. Available from: https://www.drugsandalcohol.ie/40465/

3    Maharaj T, Fitzgerald N, Gilligan E, et al. (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/