Capsule Commentary on Stephens et al., Who Needs Inpatient Detox? Development and Implementation of a Hospitalist Protocol for the Evaluation of Patients for Alcohol Detoxification

Excerpt

In this paper, Stephens et al.1 describe the development, implementation, and outcomes of a protocol to determine which patients presenting to an academic health center emergency department (ED) requesting alcohol detoxification require inpatient admission. Their interdisciplinary group synthesized existing evidence and developed a protocol that recommended admission for patients with a Clinical Institute Withdrawal Assessment (CIWA) score > 15, or for those with CIWA scores 8–15 and a prior history delirium tremens (DT). Admissions decreased from 18.9/month to 15.9/month post-implementation. (p = 0.037) Complete follow-up was not available for patients discharged from the ED; however; no patient discharged to outpatient treatment returned to the ED within 48 h and required inpatient admission for detoxification. Patient-centered alcohol outcomes, health-related and otherwise (patient costs, arrests, family stress, etc.) were not obtained. …