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From ED overcrowding to jail overcrowding: a cautionary tale of a Serial Inebriate Programme (SIP)
  1. Ignacio Navarro1,2,
  2. Andrew Anglemyer3
  1. 1 Collaborative Health and Human Services, College of Health Sciences and Human Services, California State University, Monterey Bay, Monterey, California, USA
  2. 2 Institute for Community Collaborative Studies, College of Health Sciences and Human Services, California State University, Monterey Bay, Monterey, California, USA
  3. 3 Department of Operations Research, Naval Postgraduate School, Monterey, California, USA
  1. Correspondence to Dr Andrew Anglemyer, Department of Operations Research, Naval Postgraduate School, Monterey, CA 93943, USA; atanglem{at}


Introduction Community-based programmes have been implemented to curtail ED use by individuals with chronic public intoxication. Among these programmes is the Serial Inebriate Programme (SIP), which aims to reduce use of ED and emergency medical services. We present the results of an evaluation of the SIP in Santa Cruz, California, including data on the participants’ police and jail history, information not considered in prior analyses of SIPs.

Methods In the present study, we used a retrospective cohort to evaluate the effectiveness of the SIP in Santa Cruz, California from 2013 to 2015. Specifically, we looked at the programme effects on participants’ arrests, nights in jail, use of the local ED and ambulance services after programme adjudication.

Results The median number of visits to the ED for participants before and after adjudication was reduced from 4 to 1, and participants showed a significant decrease in their number of jail bookings following adjudication (−4.5 bookings; p=0.004). However, the average number of nights in jail served by participants after adjudication was 2.1 times the average number of nights spent in jail spent before programme adjudication (58.5 vs 27.6 nights in jail for postadjudication and preadjudication groups, respectively; p=0.009).

Conclusions Our findings suggest that the Santa Cruz SIP had some impact in reducing participants’ use of emergency services, but at the cost of increased jail time. The burdens of placing chronically intoxicated individuals in jail for extended periods of time are not trivial and should not be overlooked when designing and implementing a SIP.

  • alcohol abuse
  • cost efficiency
  • crowding
  • emergency department utilisation
  • mental health, alcohol abuse

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  • Patient consent for publication Not required.

  • Contributors IN conceived of the study. AA and IN both performed the analyses. AA wrote the initial draft of the manuscript and both AA and IN edited the final manuscript.

  • Funding Santa Cruz County Health Services Agency funded this independent evaluation.

  • Disclaimer The funders have no role in the evaluation, study methods or present article.

  • Competing interests None declared.

  • Ethics approval This study was determined to be exempt from the Institutional Review Board review by California State University, Monterey Bay Committee for Protection of Human Subjects.

  • Provenance and peer review Not commissioned; externally peer reviewed.