title: Who needs inpatient detox? Development and implementation of a hospitalist protocol for the evaluation of patients for alcohol detoxification.
abstract: BACKGROUND
  Clinicians caring for patients seeking alcohol detoxification face many challenges, including lack of evidence-based guidelines for treatment and high recidivism rates.
  
  
  OBJECTIVE
  To develop a standardized protocol for determining which alcohol dependent patients seeking detoxification need inpatient versus outpatient treatment, and to study the protocol's implementation.
  
  
  METHODS
  Review of best evidence by ad hoc task force and subsequent creation of standardized protocol. Prospective observational evaluation of initial protocol implementation.
  
  
  METHODS
  Patients presenting for alcohol detoxification.
  
  
  METHODS
  Development and implementation of a protocol for evaluation and treatment of patients requesting alcohol detoxification.
  
  
  METHODS
  Number of admissions per month with primary alcohol related diagnosis (DRG), 30-day readmission rate, and length of stay, all measured before and after protocol implementation.
  
  
  RESULTS
  We identified one randomized clinical trial and three cohort studies to inform the choice of inpatient versus outpatient detoxification, along with one prior protocol in this population, and combined that data with clinical experience to create an institutional protocol. After implementation, the average number of alcohol related admissions was 15.9 per month, compared with 18.9 per month before implementation (p = 0.037). There was no difference in readmission rate or length of stay.
  
  
  CONCLUSIONS
  Creation and utilization of a protocol led to standardization of care for patients requesting detoxification from alcohol. Initial evaluation of protocol implementation showed a decrease in number of admissions.
authors.affiliation: Division of General Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, 5034 Old Clinic Building, CB#7110, Chapel Hill, NC, 27599-7110, USA, stephenj@med.unc.edu.
authors.forename: John R
authors.initials: JR
authors.lastname: Stephens
authors.forename: E Allen
authors.initials: EA
authors.lastname: Liles
authors.forename: Ria
authors.initials: R
authors.lastname: Dancel
authors.forename: Michael
authors.initials: M
authors.lastname: Gilchrist
authors.forename: Jonathan
authors.initials: J
authors.lastname: Kirsch
authors.forename: Darren A
authors.initials: DA
authors.lastname: DeWalt
mesh_terms: D026683:Advisory Committees / Q000592:standards / Q000639:trends; D000437:Alcoholism / Q000175:diagnosis* / Q000628:therapy*; D002985:Clinical Protocols / Q000592:standards; D006301:Health Services Needs and Demand / Q000592:standards* / Q000639:trends; D020445:Hospitalists / Q000592:standards* / Q000639:trends; D006760:Hospitalization / Q000639:trends; D006801:Humans; D016730:Program Development / Q000592:standards*; D011446:Prospective Studies