Case Study

New protocol standardizes care for inpatients with alcohol dependency

It’s estimated that 5 percent of adults (15 million people) in the U.S. abuse or are dependent on alcohol. Many people with alcoholism also have other behavioral health needs. When admitted to a hospital, often for a separate medical or surgical problem, their care can become complex and difficult.

A case review of such patients at Hallmark Health System (HHS) revealed inconsistencies in how the alcoholrelated portion of patients’ hospital stays was managed. “Unwarranted variation can lead to potentially serious patient safety issues,” said Vice President of Medical Affairs and CMO Steven Sbardella, MD, “so we needed to quickly determine and implement a more standardized approach.”

A group of stakeholders from psychiatry, nursing, pharmacy, education and other areas, plus hospitalists, worked together to vet a variety of approaches and settled on the Clinical Institute Withdrawal Assessment for Alcohol (CIWA), the current best-practice tool for assessing and managing alcohol withdrawal. “CIWA is an objective, 10-item scale that our staff can use when evaluating a patient,” he said, “and it automatically directs clinicians to the appropriate next steps based on its scoring system.”

Once CIWA was adopted, HHS educators worked “in blitz fashion and at warp speed,” said Sbardella, to spread the tool throughout the system. “Everyone who needed to step up did so, and we are now much more consistent in how we care for patients needing detoxification.”

To further ensure patient safety, the CIWA tool also has been linked to the HHEWS (Hallmark Health Early Warning System) tool, a similar objective assessment of vital signs for inpatients at risk. “We found that some patients required more than just CIWA, particularly when some of their symptoms may not be related to alcohol withdrawal,” said Sbardella.


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