Detection of alcohol misusing patients in accident and emergency departments: the Paddington alcohol test (PAT)
OBJECTIVE
To develop an effective but practical screening questionnaire for use by accident and emergency (A&E) staff to detect alcohol misuse early on in its natural history, without unreasonably prolonging patient waiting times; and to integrate an alcohol health worker (AHW) into A&E to provide counselling for referred patients.


METHODS
Two pilot studies for adult patients were undertaken to develop the 1 min Paddington alcohol test (PAT), which has only three compulsory questions for detecting alcohol misuse: two cover peak consumption and frequency of possible binge drinking, and the third asks whether in the patients' view their attendance at A&E was alcohol related. The use of the PAT was validated in "appropriate" adult patients over a one year period. Patients found to be positive were invited to attend the A&E review clinic for counselling by the AHW.


RESULTS
The development of the PAT resulted in a referral rate of one patient per 158 A&E adult attenders, facilitating a counselling rate of one patient per 263 A&E adult attenders by the AHW. This counselling rate is a 10-fold increase on the rate of one patient per 2610 adult attenders found in a study undertaken during 1988-90.


CONCLUSIONS
The use of the PAT is one practical method for A&E staff to detect the alcohol misusing patient for referral to a departmental alcohol health worker.
Department of Accident and Emergency Medicine, St Mary's NHS Trust, London, UK.
S G
SG
Smith
R
R
Touquet
S
S
Wright
N
N
Das Gupta
D000328:Adult; D000437:Alcoholism / Q000517:prevention & control*; D003376:Counseling; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005568:Forms and Records Control; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D010865:Pilot Projects; D012017:Referral and Consultation; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires / Q000592:standards*