Dr Chris Daly is the Lead Consultant Psychiatrist at the Greater Manchester Mental Health NHS Foundation Trust. In this blog, he describes the successful pilot and implementation of Rapid Access Detox Acute Referral (RADAR) in response to high levels of alcohol-related admissions to A&E.
The need for RADAR
“It has given me the time to reflect on my past. Speaking to professionals has given me time to sort my head out and find a way to put things in place with help away from here.” – patient
Rapid Access Detox Acute Referral (RADAR) was first piloted at Greater Manchester Mental Health NHS FT in 2012. We developed this innovative model of care to ease the burden on local acute trusts, who were seeing high levels of alcohol-related admissions.
The data at the time indicated that 35% of A&E attendances and as many as 70% of night time presentations were alcohol-related. One in eight hospital admissions were due to alcohol.
Many individuals were in hospital again and again because their underlying issues with alcohol were not being addressed. To improve these clinical outcomes we needed to support these patients to be in a therapeutic setting, dedicated to treating the harmful use of alcohol and other drugs, rather than a general acute hospital ward. Treating them when in crisis is considered a treatable moment.
RADAR in practice
“From inception to discharge I have received and gained absolute positivity from both staff and others like myself. The whole experience has inspired me to attain my goals for the future.” – patient
RADAR provides rapid access for patients directly from acute hospitals across Greater Manchester who are presenting with alcohol dependence, acute alcohol withdrawal and who would otherwise require admission to an acute hospital bed. Admission is to a specialist inpatient alcohol detoxification unit with 24-hour medical cover and multidisciplinary team support – the Chapman-Barker Unit, on the Greater Manchester Prestwich site. The service reduces the burden on the acute hospital sector by reducing length of stay, successfully completing detoxification, reducing the rates of relapse and admission, and does this in a timely and effective manner in order to promote recovery.
Individuals are approached following presentation to an A&E department, if medically appropriate, with the offer of a five to seven day, medically-managed detox and an opportunity to attempt to break the cycle of addiction and the frequent need for acute hospital care. Admissions can take place 24/7 with a simple referral pathway.
During an inpatient stay at RADAR, not only is detox appropriately managed, but a range of evidence-based, psycho-social interventions are delivered. Care includes physical health management and mental health treatment, with a strong focus on engagement and aftercare which leads to better recovery outcomes from detoxification and reduced re-presentation to acute hospitals in future.
Does it work?
“I have been treated with dignity and respect and upmost as a human being. Not as a waste of space.” – patient
There was an external evaluation by colleagues at Liverpool John Moores University. The results have been incredibly positive. In our first two years, 636 patients were admitted, from across 11 A&E/acute hospitals. RADAR was independently evaluated and the findings showed a high level of effectiveness:
- 64% of patients were not previously known to alcohol services, indicating that RADAR was capturing people at their ‘treatable’ moment who were otherwise not accessing services
- 95% completed the RADAR treatment and left the unit fully detoxified
- 60% were either abstinent or drinking in a controlled way three months after admission
- 75% had no hospital admissions in the three months following their RADAR treatment
- 50% of the people included in the sample were what are known as ‘frequent fliers’ (regular presenters at A&E) so we can conclude RADAR was impacting positively on reduced acute hospital usage
- 80% of service users reported they were delighted with the service and referenced our therapists non-judgemental approach and environment as contributing factors to this
Alcohol admissions are costly, however, thanks to RADAR addressing the issue of alcohol dependency directly and effectively the external economic evaluation indicated we saved over £1.3million over the first two years of operation.
RADAR in lockdown
When responding to the COVID-19 pandemic, as an NHS trust, we anticipated an increase in demand for acute hospital beds in relation to alcohol withdrawal. We recognised that individuals with alcohol dependence may be increasingly concerned about their drinking and were finding supplies of alcohol more difficult to obtain e.g. whilst isolating.
We therefore took the decision to expand the capacity of RADAR to support our acute colleagues, increasing the number of beds from 8 to 15. We anticipated there would be increased rates of withdrawal and we did not want our frontline emergency colleagues being diverted from COVID-related care to work with these individuals. The numbers of RADAR admissions have definitely increased and we are evaluating what the impact of the Covid pandemic has been on the patients presenting through RADAR.
We remain extremely proud of our RADAR team and our acute care colleagues who have worked side by side with us to make the initiative so successful. We know we have saved and improved many lives. We will continue to support those who need this vital care, treatment and support to live an optimistic life beyond addiction and into recovery.
Information on RADAR
The hospitals we accept referrals from are:
- Salford Royal FT
- Wigan and Leigh (RAEI)
- North Manchester General Hospital
- Central Manchester (MRI)
- South Manchester (Wythenshawe)
- Royal Bolton Hospital
- Bury (Fairfield)
- Royal Oldham Hospital
- Rochdale Infirmary
- Tameside General Hospital
- Stockport (Stepping Hill)
- Trafford General
We acknowledge the help and support from all these hospitals and especially the Alcohol Care Teams and Alcohol Nurse Specialists in the acute trusts
Contact the team
Chapman-Barker Unit, Greater Manchester Mental Health NHS Foundation Trust, Bury New Road, Prestwich, Manchester, M25 3BL
Telephone: 0161 358 2090
Written by Dr Chris Daly
This blog was published with the permission of the author. The views expressed are solely the author’s own and do not necessarily represent the views of the Alcohol Health Alliance or its members.