Nurses 'don't want drunks in A&E'

Drunk people should be kept out of A&E departments and treated elsewhere, a number of nurses have said.

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Treating intoxicated patients in A&E is a "waste of resources", the Royal College of Nursing's (RCN) annual congress in Liverpool heard.

Some nurses at the conference issued a call for an investigation into the best location of care for inebriated patients, such as alcohol recovery centres and so-called drunk tanks and booze buses.

Drunk people can have a "significant" effect on other patients in the emergency room as well as on staff and they can increase waiting times, delegates were told.

But other nurses raised concerns that if drunk people are not treated appropriately, head injuries could easily be dismissed as intoxication which could lead to devastating consequences.

Others said that alcoholism is an illness and should be treated as such.

Uwem Otong, from the south east Northern Ireland branch of the RCN, said: "I do agree that people who are intoxicated need help. But the truth remains that alcohol intoxication is not an accident.

"A&Es in all countries are under intense pressure.

"At a time in which the NHS is facing financial burden, it is important that services are channelled properly.

"My own thinking is that somebody takes alcohol knowing exactly what he or she is doing. With that in mind, I would suggest a situation in which people who are intoxicated are moved to a different environment to give room to those who are actually having accidents, or those that require emergency care.

"With other ailments or problems, if a GP is capable of dealing with that problem that issue should not go to A&E. So why should alcohol intoxication be accepted in A&E? I think it is a waste of resources."

Nykoma Hamilton, from the RCN's Fife branch, said: "Sadly this topic is not new. We have seen a growth in the binge-drinking culture across the UK.

"Surely A&E being full of drunk people will slow down treatment times - there has to be a better solution.

"So what about setting up an area adjacent to, but separate from, A&E at the weekends, when it's the most busy, staffed by nurses - but not the A&E staff, they need to be in A&E.

"A journal article from New Zealand highlighted that at the weekend, alcohol-related patients were the main cause of violence to A&E staff, they increased staff workload, increased waiting times and increased the anxiety among other patients.

"This must have a wearing effect on staff morale - they didn't go to work in A&E just to treat a bunch of drunk people every weekend who have fallen over and hurt their face.

"It's time to step back and re-think. A&E is not appropriate but neither are wards full of vulnerable elderly people."

But Mike Smith, who has been an emergency nurse for 23 years, told delegates: "How can we be sure that intoxicated brain injury patients receive the most appropriate care outside of A&E?

"Will other providers be able to detect subtle neurological changes? Will they understand how drugs and comorbidities can affect patients and their safe recovery?"

When asked about the debate, Dr Peter Carter, chief executive and general secretary of the RCN, said: "When someone is inebriated, just thinking 'they're drunk, let's put them in a bus or something', the problem with that is that if they have fallen over and got a subdural haematoma or some other condition people could potentially die.

"I think you need far more than some sort of place just to deposit people when they are inebriated.

"At the point where they are picked up they need to have a proper assessment, which will include a neurological assessment. And you would find that a lot of people, although inebriated, will still need to come to A&E."

He said the problem of treating people with alcohol-related harm has "undoubtedly" got worse in recent years, adding: "There was a time when this was a Friday and Saturday night phenomena but nurses say that's not the case now, it's round the week.

"There is hardly a time when there isn't someone who has got an alcohol-related issue in that A&E department.

"It is a contemporary phenomena that more and more people, not just young people but people of all ages, have been drinking too much."

But he said he did support the idea of pilot schemes to see whether or not people could be treated outside of the emergency room, but these facilities would need to have all of the appropriate diagnostic tools to exclude the possibilities of a physical problem.

"If you could find ways that people could be safely cared for without going to A&E that's got to be a good thing," he said.

Dr Carter said that drunk people have a "significant" impact on other people in the emergency room, adding: "People that come in inebriated and unconscious they require a lot of nursing care and that detracts from care being given to others, but also there are examples of people coming in an aggressive state, perhaps having been in a fight, blood everywhere, careering around the place - it can make things very difficult."

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