Identification of Time to Treatment for Alcohol Withdrawal in the Emergency Department

Abstract

The purpose of this project was to determine the time between arrival, assessment, and treatment for patients presenting with alcohol withdrawal syndrome (AWS) to the emergency department (ED) as well as to identify patient and environmental factors that may prolong initiation of the implementation of the clinical institute withdrawal alcohol (CIWA-Ar) protocol for assessment and treatment of AWS. There is clear evidence that rapid assessment and treatment of AWS improves cost, quality, risk, safety and patient outcomes. This project found that patients in the emergency department at Banner University Medical Center South campus (BUMCS) in 2016 on average waited 2 hours and 20 minutes for initial CIWA-Ar assessment and 50 minutes for medication to be administered. When taking into account the physiological process of AWS and the highly variable nature of ethanol metabolism this timeline is suboptimal and significant reduction of these times are recommended. The only factor that was significantly associated with increased wait times was elevated blood alcohol content (BAC). With higher BAC resulting in longer wait times. This is a concerning finding since patients experiencing symptoms of withdrawal in the presence of elevated BAC are at significantly higher risk for the most severe AWS including delirium tremens and seizure.