Professor Robin Touquet

Alcohol Misuse Service Development, St Mary’s Hospital 1988-2011

We initiated this work in 1988 to demonstrate that 46% of patients detected as misusing alcohol were motivated to re-attend the department that same week to discuss their drinking (Green et al, 1993). We developed and validated a simpler methodology. This led to the "1-minute Paddington Alcohol Test” (PAT) (Smith et al, 1996; Alcohol - can the NHS afford it? Royal College of Physicians of London, 2001).

Following the pilot cohort study (Wright et al, 1998), our randomised controlled trial (2001-2003) 'Reducing alcohol misuse in patients attending an accident and emergency department: a randomised controlled trial and economic evaluation’ (REDUCE), funded by the Alcohol Education and Research Council, compared written advise alone, versus written advice and brief intervention (BI) from an Alcohol Health Worker. With 599 patients entered, follow-up assessments were undertaken at 6 months and l2-months to review alcohol consumption, general health (including episodes of accidental or deliberate self harm) and levels of service contact to calculate direct and indirect costs: economic evaluation (Barrett et al, 2006). Not only did we demonstrate reduced consumption with B.I., but also for every 2 referrals to the AHW there was one less reattendance within the next 12 months (Crawford, Patton, Touquet et al, 2004). http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Citation&list_uids=15474136

The PAT is an evolving pragmatic clinical tool (Patton et al, 2004; 2005) that detects alcohol misuse early on in a drinker’s natural history and acts to implant the relationship between A&E attendance and alcohol misuse, thereby combating especially binge drinking by making best use of ‘The Teachable Moment’.

The worth of alcohol services in the ED at St Mary’s is highlighted in:-

1. Alcohol Concern. Making alcohol a health priority. February 2011, para 39 & 61, p.19 & 23, ref.50. http://www.alcoholconcern.org.uk/publications/policy-reports/making-alcohol-a-health-priority
2. House of Commons Health Committee. Alcohol. January 2010, para. 133, p. 51; + Recommendation 16, p.123. http://www.publications.parliament.uk/pa/cm/cmhealth.htm
3. NHS Confederation & RCP. Too much of the hard stuff: what alcohol costs the NHS. 2010, 193, p. 3. http://www.nhsconfed.org/Publications/briefings/Pages/What-alcohol-costs-the-NHS.aspx
4. DOH, signs for improvement – commissioning intervention to reduce alcohol related harm, July 2009, p. 32 & 80. http://www.alcohollearningcentre.org.uk/_library/Alcohol-Signs_For_Improvement1.pdf
5. National Audit Office, DOH, ‘Reducing Alcohol Harm: health services in England for alcohol misuse’, October 2008, page 28. http://www.nao.org.uk/publications/nao_reports/07-08/07081049.pdf
6. BMA. Alcohol misuse: tackling the UK epidemic, February 2008, page 65. http://www.bma.org.uk/ap.nsf/Content/tacklingalcoholmisuse

The above work resulted in Adrian Brown being appointed as f/t Alcohol Nurse Specialist for St Mary’s NHS Trust, 1.5.05, funded by Westminster PCT (Touquet & Brown, 2006), with a 2nd ,Win Keane, appointed October 2008. Turning Point took over responsibility for this work November 2010. As a result of our Blood Alcohol Concentration (BAC) studies – in liaison with Dr Paul Holloway, Chemical Pathology – BACs, from May 2006, were requested 24/7 as urgent requests, with results returned on the computer along with other emergency work e.g. Glucose and Creatinine & Electrolytes within 1 hour. From 2008 BACs have been requested routinely for the top three presenting conditions to the Resuscitation Room - Trauma, Collapse, Psychiatric - 'TCP'.

The above work culminated in: PAT(2009), including clinical signs and when to order BAC: http://alcalc.oxfordjournals.org/cgi/reprint/agp016?ijkey=HImeNEO7f6izT0F&keytype=ref

Nationally we won the inaugural national ‘Hubcapp Project of the Year’ 2010 award – Hub of Commissioned Alcohol Projects and Policies – www.hubcapp.org.uk/gwaq. Hubcapp is an online resource of local alcohol initiatives throughout England, commissioned by the DOH and is part of its Alcohol Improvement Program.

PAT 2011: http://www.alcohollearningcentre.org.uk/Topics/Browse/Hospitals/EmergencyMedicine/?parent=5168&child=5169

Internationally we have had published Chapter 12.4, ‘Pragmatic Implementation of Brief Interventions’

Touquet R, Brown A. In Alcohol and Injuries; Eds Cherpitel CJ, Borges G, Giesbrecht et al.’

World Health Organization, 2009. http://www.who.int/substance_abuse/msbalcinuries.pdf

Work in progress from 2011

1. The National Alcohol Brief Intervention Research Consortium. For a national evaluation of screening and intervention for alcohol misuse, liaising with colleagues from St George’s Hospital Medical School, Newcastle University, Alcohol Concern and York University, to examine the feasibility and impact of deploying Alcohol Health Workers in AEDs (£990K), primary care and the criminal justice system (courts) in England and Wales.

Professor Colin Drummond, St George’s, leads this £3.2 million Project, announced 1.11.05 by Public Health Minister Caroline Flint Project web site: http://www.sips.sgul.ac.uk

2. Patents:- Developing an ‘Alcostick’ test for [alcohol]blood, to be combined with a ‘glucostick’, especially for use with obtunded patients in EDs. Working in partnership with Mr Jim Campbell. BSc CEng MIM MIBF Principal Scientific Officer, Surescreen Diagnostics Ltd.

1st Patent filed: November 2006, Jim Campbell & Robin Touquet, Application Number: GB0622212.9 www.ipo.gov.uk Title: Detection system apparatus.

2nd patent filed: No. 0900176.9 February 2009. Title: Blood Alcohol Fuel Cell.

Prototype developed as a PDA; now for outsourcing for micro-processing and manufacture.

3.. Co-applicant for £250K grant submission to ‘NHS: Research for Patient Benefit’ for Screening and brief intervention for hazardous excessive alcohol consumption in sexual health clinics: an exploratory randomised trial. Study Acronym: SHEAR (Sexual Health & Excess Alcohol: Randomised trial) NIHR Reg No. 09/9104