The “Serial Inebriate Program”. The Impact of Dozens of Frequent Utilizers of the EMS System and...
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Transcript of The “Serial Inebriate Program”. The Impact of Dozens of Frequent Utilizers of the EMS System and...
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The “Serial Inebriate Program”The “Serial Inebriate Program”
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The Impact of Dozens of Frequent Utilizers of the The Impact of Dozens of Frequent Utilizers of the EMS System and the Emergency Departments EMS System and the Emergency Departments
each day continues in Dallas Countyeach day continues in Dallas County
……and emergency and hospital resources and emergency and hospital resources continue to be distracted toward frequent continue to be distracted toward frequent usersusers
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The San Diego Effort: The San Diego Effort: Dunford JV. Dunford JV. Annals of Emergency Annals of Emergency
Medicine Medicine 2006; 47:328-3362006; 47:328-336
The Serial Inebriate ProgramThe Serial Inebriate Program
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San Diego set up a program to identify San Diego set up a program to identify the Individualsthe Individuals
placing the greatest burdenplacing the greatest burdenon the community due toon the community due to
unrelenting substance abuseunrelenting substance abuse
ChallengesChallenges
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In California it is a misdemeanor to be In California it is a misdemeanor to be publicly intoxicated.publicly intoxicated.
Using this authorization, the program Using this authorization, the program brings persons charged four times in a brings persons charged four times in a
month month into the programinto the program
The Authorizing StatuteThe Authorizing Statute
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Website: www.sandiego.gov/sipWebsite: www.sandiego.gov/sip
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Participating AgenciesParticipating Agencies
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Summary of the Problem - the impact Summary of the Problem - the impact of 529 specifically identified individuals of 529 specifically identified individuals with >5 visits/month to sobering center with >5 visits/month to sobering center
over 4 year periodover 4 year period
Cost Savings to San DiegoCost Savings to San Diego
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•409 (77%) amassed 3,318 Emergency Department visits409 (77%) amassed 3,318 Emergency Department visits•217 (41%) required 652 hospital admissions217 (41%) required 652 hospital admissions•Resulting in 3,361 inpatient daysResulting in 3,361 inpatient days•Experience from 2000 -2003Experience from 2000 -2003•308 (58%) were transported by EMS 2,335 times308 (58%) were transported by EMS 2,335 times•Health care charges totaled $17.7 millionHealth care charges totaled $17.7 million•Payments for only 18% of charges were receivedPayments for only 18% of charges were received
The Cost to the Community in The Cost to the Community in San Diego before the SIPSan Diego before the SIP
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A subsequent study revealed a 50 percent reduction in use of emergency resources by this population through
the Serial Inebriate Program
A subsequent study revealed a 50 percent reduction in use of emergency resources by this population through
the Serial Inebriate Program
Cost Savings in San DiegoCost Savings in San Diegothrough the SIPthrough the SIP
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Current Efforts toCurrent Efforts toAdvance the Development ofAdvance the Development ofThe Serial Inebriate ProgramThe Serial Inebriate Program
in Dallas, Texasin Dallas, Texas
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Available Data sets Available Data sets for SIP Cross-linkingfor SIP Cross-linking
ArrestsArrestsEMS Responses and EMS Responses and
TransportsTransportsED and Psych VisitsED and Psych Visits
Setting up a SIP in DallasSetting up a SIP in Dallas
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Arrests OverArrests OverA One-YearA One-Year
PeriodPeriod
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The Continuing Burden of Services The Continuing Burden of Services that Certain Patients Requirethat Certain Patients Requireis Enormous and Expensiveis Enormous and Expensive
This ongoing massive use of This ongoing massive use of emergency services is a very emergency services is a very
real system problemreal system problem
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The Problem Patient The Problem Patient
Escalation Escalation is the ruleis the rule
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A Single Patient Presenting to Our EMS SystemA Single Patient Presenting to Our EMS SystemCurrent EMS Responses and TransportsCurrent EMS Responses and Transports
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The Same Individual at One Area HospitalThe Same Individual at One Area HospitalThe # of ED Visits Sept to October 2011 For Substance Abuse Issues The # of ED Visits Sept to October 2011 For Substance Abuse Issues
14 in September
13 in October
23 ED uses at 23 ED uses at one hospital alone!!!one hospital alone!!!
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The Same Patient’s Blood Alcohol LevelsThe Same Patient’s Blood Alcohol Levels(note the increasing frequency of ED visits (note the increasing frequency of ED visits
with severe alcohol intoxication)with severe alcohol intoxication)
The Same Patient’s Blood Alcohol LevelsThe Same Patient’s Blood Alcohol Levels(note the increasing frequency of ED visits (note the increasing frequency of ED visits
with severe alcohol intoxication)with severe alcohol intoxication)
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Sample Patient’s Presenting ComplaintsSample Patient’s Presenting Complaintsfor the last two monthsfor the last two months
Sample Patient’s Presenting ComplaintsSample Patient’s Presenting Complaintsfor the last two monthsfor the last two months
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Estimates of Total ChargesEstimates of Total Charges
Average EMS Bill = $1,000Average EMS Bill = $1,000Average ED Bill = $2,000Average ED Bill = $2,000
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Estimates of Total ChargesEstimates of Total Charges13 EMS Transports = $13,00013 EMS Transports = $13,000
23 ED Uses = $26,00023 ED Uses = $26,000
Total Emergency Use = $39,000Total Emergency Use = $39,000in Two Months Alonein Two Months Alone
Annual Community BurdenAnnual Community Burdenof ~ $250,000!!!!of ~ $250,000!!!!
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And Additional Burdens…And Additional Burdens…These are EMS Responses thatThese are EMS Responses that
might have been saving a life for a might have been saving a life for a member of the communitymember of the community
The hundreds of ED beds being taken up The hundreds of ED beds being taken up PER YEAR amounting to thousands of hours PER YEAR amounting to thousands of hours
of ED occupancy by of ED occupancy by ONE PERSON ONE PERSON
due solely to substance abusedue solely to substance abuse
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Elsewhere in TexasElsewhere in Texas
The San Antonio SIPThe San Antonio SIPLeon EvansLeon Evans
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Efforts Underway in DallasEfforts Underway in Dallas
Gaining IRB approval to bring the available Gaining IRB approval to bring the available databases together for studydatabases together for study
Identifying participating agencies Identifying participating agencies
Looking for potential additional Looking for potential additional funding sourcesfunding sources
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Existing Resources in DallasExisting Resources in Dallas
Dallas Police DepartmentDallas Police DepartmentCrisis Intervention TeamCrisis Intervention Team
Dallas County CorrectionsDallas County CorrectionsJudicial SystemJudicial System
The Salvation ArmyThe Salvation ArmyThe BridgeThe Bridge
Dallas Fire/RescueDallas Fire/RescueParkland Hospital/ UT SouthwesternParkland Hospital/ UT Southwestern
DCHD COPC ClinicsDCHD COPC ClinicsPsychiatric UnitsPsychiatric Units
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The Challenge:The Challenge: Finding a More Finding a More
Definitive Intervention for Definitive Intervention for the Chronic Inebriate whilethe Chronic Inebriate while
Protecting our Valuable Protecting our Valuable but Limited Resourcesbut Limited Resources
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Thank You!!Thank You!!
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[email protected]@utsouthwestern.edu