Pilot alcohol clinic eliminating 83% of return emergency visits

AMIC_Event.jpg

Dr. Kim Corace, Dr. Melanie Willows, Brynna Lemmex, Slavica Popovic,Carelle Levac, and Dr. Christine Saveland. Missing: Pam Jackson, Nick Shubert,Nathaniel Leduc, Dr. John Grymala

People who work in emergency departments know there are certain people who come in needing help more often than others. 

Many of these frequent visitors at the emergency department have substance use problems, mental illness, or both. For those with substance use problems, the vast majority struggle with alcohol problems.

“We have a significant portion of people with alcohol use problems coming to the emergency department, then coming back again within 30 days for similar reasons,” says Dr. Kim Corace, director of clinical programming and research at The Royal’s Substance Use and Concurrent Disorders Program.

“This shows that these people aren’t getting the help they need.”
Back in May 2016, a new rapid-access medical alcohol withdrawal clinic opened here at The Royal.
“Since May 2016, the clinic has eliminated 83 per cent of its patients’ 30-day returns. More than that, it has reduced alcohol-related emergency visits in the system by 13 per cent.”

The Alcohol Medical Intervention Clinic (AMIC) is a smart response to a challenging question: how do we reduce the number of people coming to the emergency department repeatedly, sometimes multiple times 
a month? 

As with most smart answers, this one lay in getting a bunch of people together and coming up with a really good plan. Led by the Substance Use and Concurrent Disorders Program at The Royal, a group of community partners asked the Champlain Local Health Integration Network (LHIN) to fund the project. The clinic received pilot funding until March 2018. 

Since May 2016, the clinic has eliminated 83 per cent of its patients’ 30-day returns. More than that, it has reduced alcohol-related emergency visits in the system by 13 per cent.

“This, combined with the other numbers coming in, show that AMIC is a pilot project that patients actually find helpful,” says Dr. Corace. “It’s so exciting to see all these positive outcomes, not just for the patients you serve, but for a system as a whole.” 

Bill is a 43-year-old white man with a college degree. He lives alone and works a full-time job, but is severely dependent on alcohol. Meanwhile, he has symptoms of both depression and anxiety. 

Bill is the ‘average’ client at The Royal’s Alcohol Medical Intervention Clinic, but he’s not every client. One in five patients is under 30. One in three is female, which is significant because women with alcohol addiction are vastly underserved. One in 10 AMIC patients is at risk of losing his or her housing.

“This is a pilot that patients really find helpful, and the numbers don’t lie — it’s reducing the strain on our crowded emergency rooms by bringing these people to a place where they can get the best help at the time they need it the most.”

Dr. Kim Corace, director of clinical programming and research, Substance Use and Concurrent Disorders Program, The Royal
Here’s how it works: a patient comes in to the emergency department at one of The Ottawa Hospital’s two sites with an alcohol-related issue. They’re referred to AMIC, and told they can drop in anytime between 8 and 11a.m. Monday to Friday. An astonishing 61 per cent of them do. Most of them show up within three days of the referral, and then continue to come. 

“This is an unusually high rate, and it shows that the service is actually accessible and done in a way that’s acceptable for these clients,” says Dr. Corace.

They come to The Royal, and are met with the services of an interdisciplinary team that can provide treatment for withdrawal and triage the patient to the best location for care. Whether that’s at The Royal, or with our community partners, AMIC is the hub where they find help when they need it most.

“It’s the ideal time to intervene when someone has just had an emergency room visit related to their alcohol use. Now, they are able to get help when they need it most — right away when they are motivated to make changes and accept help,” says Dr. Melanie Willows, clinical director at The Royal’s Substance Use and Concurrent Disorders Program. 

The partnerships AMIC represents are the key to its success. Strong partnership with The Ottawa Hospital, and strong connections and support from community organizations mean that patients can get help quickly. These connections include an Ottawa Addictions Access and Referral Services (OOARS) navigator who helps connect AMIC clients with the most appropriate community resources. 

“This is a pilot that patients really find helpful, and the numbers don’t lie — it’s reducing the strain on our crowded emergency rooms by bringing these people to a place where they can get the best help at the time they need it the most,” says Dr. Corace. 

The pilot project has funding until March 2018.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s