The aim of this research was to examine the role of alcohol and alcohol-related cognitive impairment in the clinical presentation of adults in-patients less than 65 years who are 'hard to discharge' in a general hospital. The authors conducted a retrospective medical file review of inpatients in CUH referred to the discharge coordinator between March and September 2006.

Of 46 patients identified, the case notes of 44 (25 male; age was 52.2 ± 7.7 years) were reviewed. The average length of stay in the hospital was 84.0 ± 72.3 days and mean lost bed days was 15.9 ± 36.6 days. The number of patients documented to have an overt alcohol problem was 15 (34.1%). Patients with alcohol problems were more likely to have cognitive impairment than those without an alcohol problem [12 (80%) and 9 (31%) P = 0.004]. Patients with alcohol problems had a shorter length of stay (81.5 vs. 85.3 days; t = 0.161, df = 42, P = 0.87), fewer lost bed days (8.2 vs. 19.2 days; Mann-Whitney U = 179, P = 0.34) and no mortality (0 vs. 6) compared with hard to discharge patients without alcohol problem.

The authors concluded that alcohol problems and alcohol-related cognitive impairment are hugely over-represented in acute hospital in-patients who are hard to discharge. Despite these problems, this group appears to have reduced morbidity, less lost bed days and a better outcome than other categories of hard to discharge patients. There is a need to resource acute hospitals to address alcohol-related morbidity in general and Wernicke-Korsakoff Syndrome in particular.