Alcohol withdrawal in acute hospital settings: the SSA talks to Rachel Coleman
Rachel Coleman started her SSA-funded PhD looking at treatment for alcohol withdrawal in acute hospital settings at the University of Hull in October 2020. Rachel is supervised by Professor Thomas Phillips (University of Hull) and Professor Simon Coulton (University of Kent). The SSA (belatedly) caught up with Rachel to find out more.
SSA: Can you tell me what you PhD looks at?
Rachel Coleman: “Yes, the overall focus of my PhD is measurement and management of alcohol withdrawal in acute hospital settings. There’s been a decrease in specialist inpatient beds for alcohol withdrawal and alcohol treatment and at the same time there’s been an increase in alcohol-related admissions in general as well as admissions for alcohol withdrawal to acute hospital settings. We can’t be sure that those two things are related but they have happened at the same time.
I’m interested in how to meet that need, how to deal with and support staff to meet that need and how to make sure that the patients are getting the treatment that they need. Because specialist care and the people who specialise in alcohol withdrawal treatment are more clustered around the drug and alcohol services and the alcohol inpatient units and tend not to be based in the acute hospitals. Yorkshire and Humber have a higher than average prevalence of alcohol related admissions, so it’s relevant to the work the Addictions Research Department are doing in Hull.”
What are you planning to do within your PhD?
“I’m doing a systematic review looking at what’s out there on identification of alcohol withdrawal in acute hospitals. I’ve also applied for access to data on hospital episode statistics through NHS digital. Using NHS data is interesting. The dataset we’ve got is 2017 to 2018 and covers every single admission for England that year. It’s massive, it’s 9 million lines of data. The great thing from a research point of view is that it’s real life population level data.
They also record ICD-10 codes and there’s a code for alcohol withdrawal, so we’ll be able to pick out predictors of alcohol withdrawal in acute hospitals. We’ll be able to see if there is something in the routinely collected data that we can use to develop a risk score for people of going into alcohol withdrawal. So almost going backwards, identifying those cases and developing a prognostic model or a way of developing a risk score. We’re just getting the approval from NHS digital to start that process.
The main piece of work, however, will be an observational study looking at a comparison of care in acute hospitals and specialist alcohol settings. We’ll be looking at 3 months of care in an acute hospital, maybe somewhere like Hull Royal Infirmary, and then looking at an inpatient detox unit that’s got that specialism and just seeing the differences in how people are monitored and how they are managed.”
Do you have any thoughts as to why acute hospital services might struggle with alcohol withdrawal management?
“I think that there’s a difference in the acute setting because they’re obviously looking after a lot of different things. I think there might be certain elements of stigma. I know that that’s something that I’ve spoken to a service user group about, and they were delighted to hear that that work was being done, because they said they had felt stigmatised when they had gone into the acute hospitals with alcohol withdrawal.
I think there are also some issues with maintaining a level of training, because the studies have shown that that degrades over time. You can provide training on a particular issue, but if it’s not maintained and coming from a supervisory level as well, it’s not going to be sustained because these people are working hard, they’re potentially short-staffed working in busy, stressful situations.”
What do you know about people who are admitted to acute hospitals with alcohol withdrawal?
“There are potentially two groups. There are the people who come in for something else; maybe they’re intoxicated, they’ve had a fall, or they have got other health conditions. There’s a lot of complexity from a clinical point of view from those people and they’re coming into hospital and then go into alcohol withdrawal.
There are then people coming in with alcohol withdrawal. There are fewer primary withdrawal admissions, certainly from the data it seems to be more of a secondary thing. The people I spoke to in the service user group said there was an issue of trying to stop drinking and then experiencing severe withdrawal symptoms, and then being admitted to hospital.”
What first drew you to research in the addictions field.
“My undergrad degree was in psychology. I always wanted to work in mental health more broadly and more specifically in addictions. My first job out of university was working with a psychosis service, I was looking to get a bit more research experience and then a job working as a researcher in an Addictions Service came up. I’d love to say that it was a really planned thing and that I knew exactly what I wanted to do. It was something I was interested in and looking out for, but it was just the right job at the right time for me really.
That was just a great opportunity for me, and I learned a lot because I was embedded in the office with all the community alcohol team nurses. I wasn’t a clinician, but I was part of the Multi-Disciplinary Team meetings, just overhearing the stuff I learned so much in that setting and I got to be involved in alcohol research through King’s because Tom (my now supervisor) was doing his PhD at King’s and was a Consultant Nurse for Hull and East Riding Addictions, as well as being PI on many national alcohol studies”
So how did you get to the current PhD?
“I did that job and then did a few other jobs as services changed and got recommissioned. I then did a Masters in York. I’d always wanted to do a PhD and spoke to Tom Phillips, my first supervisor, and said ‘look, what do you think?’ and then we spoke to Simon. We just had a bit of a conversation about what we all thought of the ideas and then developed the application, put it in and that was it. So, it seemed like the right time, Tom had been doing some work which was relevant, and was employed as a Professor of Addictions at the University of Hull by that point and I’d just finished in York. So, it had just kind of all came together really.
I’m excited to keep doing it and was really chuffed to get the funding, it was a little bit of the right place at the right time and the right team.”
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