Zara Quigg: Violence and TIIG Research Manager

Centre for Public HealthWHO Collaborating Centre for Violence Prevention

Alcohol-related data collection in emergency departments: The Wirral model

ObjectivesObjectives

• Trauma and Injury Intelligence Group (TIIG)• The Wirral Model

– Alcohol-related attendances– Reporting mechanisms– Interventions– Outcome

• TIIG development across the North West

TIIGTIIG

• Funding: local partners

• Injury surveillance system

– Intentional / unintentional

• Informing injury prevention strategies

• Brings together a variety of data sources

• Focus: ED data sharing

Childhood injuries

Falls

Violence / alcohol

4/4

5/5

6/6 12/12

4/4

ED data ED data Existing data items

– Injury group Assault, sports injury, RTC, self harm

– Patient demographicsGender, age, area of residence

– Date / time of attendance– Location of incident

e.g. public place / home– Arrival / referral method– Disposal method (e.g. admitted)

Additional fields

ViolenceCore

1. Time / date2. Location assault (e.g. pub name)3. Assault type (e.g. weapon used)

Enhanced

4. Relationship with attacker5. Number of attackers 6. Gender of attackers 7. Reported to the police8. Attacker consumed alcohol9. Motive

Expansion of existing fields- Injury group: Fall / burns- Location: where in the home

- e.g. Kitchen / stairs

Additional fields

Alcohol

1. Had you been drinking alcohol within three hours prior to the incident occurring?

2. Where did you consume / purchase your last drink?

The Wirral ModelThe Wirral Model

Figure 1: Proportion of injury attendances that are alcohol-related by year, Arrowe Park ED

• ED data collection 02/03 (baseline 03/04)• PCT / CSP strategies

Target: reduce alcohol-related assault attendees by 15% over three years

The Wirral ModelThe Wirral Model

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.012

.00

- 13

.59

14.0

0 - 15

.59

16.0

0 - 17

.59

18.0

0 - 19

.59

20.0

0 - 21

.59

22.0

0 - 23

.59

0.00

- 0

1.59

02.0

0 - 03

.59

04.0

0 - 5.

59

06.0

0 - 07

.59

08.0

0 - 09

.59

10.0

0 - 11

.59

Time group (hr)

Perc

enta

ge

Sunday

Friday

Saturday

Figure 2: Assault attendances by time and day of attendance, Arrowe Park ED 2008/09

• 40% of assault cases have been drinking

• 74% between 2am and 4am weekend nights

The Wirral ModelThe Wirral ModelFigure 3: Proportion of attendances to Arrowe Park ED identified as alcohol-

related, under 18s only by age, Arrowe Park ED, 2007/08

The Wirral ModelThe Wirral Model

Age

Gender

Alcohol Circumstances Outcome

13 Male 2-3 litres Cider

StreetWith friendsPurchased from shopDrank previously Birthday

DischargedReferred to RESPONSE

13 Female

3 glasses wine (Lambrini)

StreetWith friendsPurchased from shopDrinks regularlyKnown repeat attendeeFriends drinking

Assault-related injuryAdmitted to hospitalSafeguarding concerns identified - referred to social services

15 Female

4 units Cider

ParkWith friendsDrank previously Socialising

Referred to Paediatrics for observation overnightHead injury assessmentNo injuries identified

14 Female

2 glasses wine (Lambrini)Offered Whizz and vodka

StreetWith friendsObtained from friendsDrank previouslyPeer pressure to drink and fight

Assault-related injury DischargedSafeguarding concerns identified - referred to social services

15 Female

Cider / Alcopop

House partyWith friendsObtained from friendsHouse party

Assault-related injuryAdmitted to hospitalSafeguarding concerns identified - referred to social services

Table 1: Alcohol-related attendances by demography, alcohol consumed, circumstances surrounding

consumption and outcome, Arrowe Park ED

Two week alcohol audit

• Electronic data collection identified 13 alcohol-related attendees (<18)

• 1.6% of all attendees

•Audit identified 5• Female• Cider / Lambrini• Drank in street / park•Purchased from shop•3/5 admitted to hospital

ReportingReporting

Tackling Knives Action Programme (TKAP) project to Enhance Violence Prevention

through ED Data Sharing

[Wirral BCU (Arrowe Park data only)]

Overview of ED Data

[10/05/10 to 23/05/10]

InjuriesVolume in

reporting periodAverage

age Male FemaleVariation on previous

period

Knife related 0 - - - -1

Other sharp implement 0 - - - Same

Gun related 0 - - Same

Blunt implement 1 19 1 - -2

Physical assault (no weapon) 33 25 26 7 Same

Glass 2 21 1 1 +1

Other 0 - - - Same

Unknown/refused to answer 2 32 2 -2

‘Hot’ Locations in Reporting PeriodLocation Weapon Date/Time of assault N AggregateWoodville Road Bottle 10/05/10 / 10/05/10 09:45/ Unknown 2 5New Brighton Promenade 14/05/10 / 22/05/10 23:00 / 22:15 2 2Birkenhead Central Train Station 14/05/10 15:30 1 2Borough Road 23/05/10 17:45 1 3Bebington Road 15/05/10 07:00 1 1Ben Nevis Road Unknown Unknown 1 1Bentinck Street 22/05/10 03:00 1 1Bidston Leisure Centre 12/05/10 20:30 1 1Bidston Moss B&Q 19/05/10 08:30 1 1Chamberlain Street 20/05/10 20:30 1 1Grange Place 20/05/10 18:30 1 1Hoole Road Blunt Object 16/05/10 17:30 1 1Larch Road Unknown Unknown 1 1Neston Kebab House 23/05/10 01:30 1 1North End 13/05/10 23:00 1 1Pembroke Court 11/05/10 16:30 1 1RJs 23/05/10 13:00 1 6Seabank Road 15/05/10 22:00 1 1St Caths Hospital O/S 22/05/10 22:30 1 1St John Plessington School 13/05/10 Unknown 1 1St Pauls Road Bottle 22/05/10 21:00 1 1Ward 18 APH 13/05/10 01:40 1 1West Kirby Train Station 22/05/10 21:00 1 1Whiteheath Way 18/05/10 21:00 1 1

Violence occurs in Town and City Centres yet perpetrators and victims live elsewhere

Assault Presentation to

Accident & Emergency by Deprivation of

Residence

ReportsReports

InterventionIntervention

CCTVStreet Lighting Licensing Alleygates

• Development, implementation and monitoring of local alcohol and violence

prevention strategies / prevention initiatives

• Targeted policing and licensing enforcement

• AMEC / TCVP / TKAP

• Pubwatch

• Best Bar None / Think 21 campaign

• Targeted social marketing campaigns

Event Planning

PreventionPrevention

• England match days (EMD)• 33% increase assault

attendances• Saturday / Thursday

• 50%• No increase during World Cup period only (accounting for EMD)

Operation XchangeOperation Xchange

• Partnership approach– ED, police, primary care– 14th to 23rd Dec 2009– ED data used to guide police

operation – Targeted policing / licensing

enforcement

• Outcomes– 3 knives recovered – 21% reduction in wounding

offences within the city centre

– 57% reduction in ED assault attendances

Marketing Campaigns

PreventionPrevention

10

12

14

16

18

20

22

24

AMEC weeks for 2005/06

Non-AMEC weeks

Rat

e of

ass

ault

att

enda

nces

/wee

k

2002/03 2003/04 2004/05 2005/06

Financial Year

AMEC 2005/06

Licensing Act and Alcohol Misuse Enforcement Campaign

EvaluationEvaluation

Arrowe Park, Wirral: 03/04 - 09/1003/04 = 3,299 / 1,48509/10 = 2,035 / 975 (38% / 34% reduction)

TrendsTrends

Est. £40,800 saved (PCT) through reduction in ED alcohol-related assault attendances

Est. £24,000 saved (provider) through reduction in alcohol-related assault admissions

North West data collection / sharingNorth West data collection / sharing

Area Violence Alcohol

Cumbria 2/3 2/3

Cheshire 1/4 1/4

Greater Manchester 7/12 4/12

Lancashire 2/5 2/5

Merseyside 5/7 5/7

North West 17/31 14/31

Number of EDs collecting and sharing alcohol and violence data with TIIG, by area

www.tiig.infowww.tiig.info

Contact details

For and more information please contact:

Zara Quigg, Violence and TIIG Research Manager0151 231 4359, z.a.anderson@ljmu.ac.uk

www.tiig.info

Centre For Public HealthLiverpool John Moores University

WHO Collaborating Centre for Violence Prevention5th Floor, Kingsway House, Hatton Garden, Liverpool, L3 2AY