People who consume alcohol at risky levels are at an increased risk of presenting to the emergency department (ED). There are a variety of methods used for detection of alcohol-related ED presentations but little guidance about the relative strengths and weaknesses for each method. This research compared and contrasted multiple detection methods for alcohol-related ED presentations and also examined the characteristics of ED patients identified as risky drinkers on a brief self-report screen compared with those detected as having an alcohol-related ED presentation. The first study, a population health survey, found that high risk drinking, high psychological distress and current smoking were all significantly associated (both independently and when combined) with a greater likelihood of presenting to an ED in the last year. The second study involved electronically searching three years of ED nursing triage text data (N=263,937) for alcohol-related terms and found that over 5% of ED presentations were related to alcohol. The third study involved comparing a number of detection methods for alcohol-related ED presentations. It found that nearly a fifth (19%) of ED presentations were detected to be alcohol-related. The strongest method was a medical records audit (72%), followed by patient self-report (67%), nursing triage text (49%) then diagnostic codes (10%). Over a fourth of ED patients were identified as risky drinkers (28%), however, just over half (51%) of these did not present to the ED for an alcohol-related reason. Among alcohol-related ED presentations, nearly a third (31%) were not identified as risky drinkers. In a survey of ED staff, it was found that management of alcohol-related problems was not routine, and many staff appeared to lack the confidence to fully and appropriately manage ED patients with alcohol-related problems. In summary, not all patients who have an alcohol-related ED presentation usually drink at risky levels, nor do all risky drinkers present to the ED for an alcohol-related reason. Using a variety of detection methods for alcohol-related problems in the ED is recommended to enhance the impact of any intervention strategies. ED staff require additional training, resources and support to enhance their management of patients with alcohol-related problems.

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