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• The use of PAT in the emergency department
  Laura A. Backhouse
  Published on: 15 June 2011

• Published on: 15 June 2011

  The use of PAT in the emergency department

  • Laura A. Backhouse, Medical student

  Re: Systematic review of alcohol screening tools for use in the emergency department. Jones L, A. emj.2011;28:182-191 doi:10.1136/emj.2009.085324

  I read the article reviewing the accuracy of screening tools and recommending their use in the emergency department with interest. As a final year medical student, I recently piloted the Paddington Alcohol Test (PAT) in a district hospital emergency department to asses...

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  Re: Systematic review of alcohol screening tools for use in the emergency department. Jones L, A. emj.2011;28:182-191 doi:10.1136/emj.2009.085324

  I read the article reviewing the accuracy of screening tools and recommending their use in the emergency department with interest. As a final year medical student, I recently piloted the Paddington Alcohol Test (PAT) in a district hospital emergency department to assess its suitability, and highlight the importance of alcohol screening to ED staff. Prior to the study, no alcohol assessment protocols or tools were used - a problem similarly seen across UK emergency departments1, 2 despite the recognised benefits of using such tools.3 I feel this is a missed opportunity as PAT for example, has been shown to reduce patient alcohol consumption and hospital re-attendance.4 However having piloted its use over a month, there are a few points I would like to raise concerning its use in clinical practice. For those unfamiliar with the tool, PAT is a targeted four question screening test and takes one minute to complete.5 It aims to encourage the patient to 'make the connection' between their attendance and harmful drinking. Whilst PAT effectively identifies harmful and hazardous drinkers (who are more likely to benefit from early intervention),6 patient responses must be interpreted by the clinician and acted upon accordingly. In my study, all PAT eligible patients exceeded their daily alcohol allowance. However 63% of these patients did not feel their attendance in ED was related to alcohol. This highlights the importance of further questioning patients who deny having an alcohol disorder and demonstrates the need to explore patients' perceptions about why they believe they presented to hospital; Those that understand the harmful effects of drinking on their health, are more likely to listen to targeted advice and therefore gain the most from screening. Speaking to recovering alcoholics, I have learnt that alcoholism is an illness and affects people from all walks of life. It is important to continually emphasise the dangers of alcohol misuse, as persistent reminders may eventually motivate the 'revolving door patient' to seek further help and change their behaviour. Groups such as Alcoholics Anonymous offer invaluable support and are worth recommending to patients. In the meantime, I await the results of the SIPS trial3 but would encourage the use of PAT in the emergency department. I appreciate ED can get very busy but I believe screening tools can facilitate alcohol education, usefully guide clinicians to identify hazardous drinkers and with time can help reduce the increasing burden of alcohol misuse on the National Health Service. References

  1. Cunningham RM, Harrison SR, McKay MP, et al. 2010. National survey of emergency department alcohol screening and intervention practices. Annual Emergency Medicine 55:556-62.

  2. Crawford MJ et al. 2004. Screening and referral for brief intervention of alcohol-misusing patients in an emergency department: a pragmatic randomised controlled trial. Lancet 364, 1334-9.

  3. Coulton, S et al. 2009. Screening and brief interventions for hazardous alcohol use in accident and emergency departments: a randomised controlled trial protocol. BMC Health Services Research. 9:114. [Online] Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2712466/pdf/1472 -6963-9-114.pdf [Accessed 6th January 2011]

  4. Patton, R. Hilton, C. Crawford, MJ et al. 2004. The Paddington Alcohol Test: a short report. Oxford Journals Alcohol and Alcoholism. 39:266-8. [Online]. Available at: http://alcalc.oxfordjournals.org/content/39/3/266.abstract [Accessed 6th January 2011]

  5. Touquet R. Brown A. 2009. Assessment and Detection. PAT (2009) Revisions to the Paddington Alcohol Test for early identification of alcohol misuse and brief advice to reduce Emergency department re- attendance. Alcohol and Alcoholism. 44(3): 284-286

  6. Paton, A. 1996. The detection of alcohol misuse in accident and emergency departments-grasping the opportunity. Journal Accident Emergency Medicine 13:306-308.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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