Quality standard

Quality statement 3: Triage assessment in specialist alcohol services

Quality statement 3: Triage assessment in specialist alcohol services

Quality statement

Adults accessing specialist alcohol services have a brief triage assessment that includes any treatment needs and associated risks. [new 2023]

Rationale

A brief triage assessment carried out as soon as possible in specialist alcohol services, and ahead of any comprehensive assessment, allows care to start that is appropriate to the person's treatment needs. The assessment produces an agreed initial treatment plan, which may include emergency or acute interventions, such as referral to an emergency department for an acute medical problem, to a crisis team for a mental health emergency, or to support for social problems.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Process

Proportion of referrals to specialist alcohol services where a brief triage assessment was carried out that included any treatment needs and associated risks.

Numerator – the number in the denominator where a brief triage assessment was carried out that included any treatment needs and associated risks.

Denominator – the number of referrals to specialist alcohol services.

Data source: Data can be collected from information recorded locally by health and social care professionals and provider organisations, for example from patient and service user records.

Outcome

a) Rates of adults accessing specialist alcohol services receiving a referral for treatment of assessed needs.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by provider organisations, for example from patient and service user records.

b) Rates of successful completion of treatment in specialist alcohol services.

Data source: The Office for Health Improvement and Disparities annual substance misuse statistics reports for adults include data on the number of adults who successfully complete substance misuse treatment for alcohol only.

What the quality statement means for different audiences

Service providers (specialist alcohol services) ensure that systems are in place for brief triage assessments to be carried out for adults accessing specialist alcohol services, and for an initial treatment plan to be produced that takes into account the person's preferences and outcomes of any previous treatment and is agreed with them. They ensure that systems are in place for care to be provided that is appropriate to the person's treatment needs.

Health and social care practitioners (such as doctors, nurses, specialist alcohol service staff and support workers) carry out a brief triage assessment with adults accessing specialist alcohol services. They agree an initial treatment plan that considers the person's preferences and outcomes of any previous treatment and facilitates any treatment that is appropriate to their assessed needs. This may include emergency or acute interventions such as referral to an emergency department for an acute medical problem, to a crisis team for a mental health emergency or to support for social problems.

Commissioners ensure that they commission services in which adults accessing specialist alcohol services receive a brief triage assessment and have an initial treatment plan agreed. They ensure that services provide care that is appropriate to the person's assessed needs.

Adults referred to specialist alcohol services have a short assessment of their needs when they first attend the service. This includes assessing their risk of harm related to their alcohol use and checking for any other health and social problems. They may then be treated or assessed in more detail if needed. They agree an initial treatment plan that considers their views and the results of any treatment they have had before.

Definitions of terms used in this quality statement

Brief triage assessment

An assessment carried out when adults first access a specialist alcohol service that assesses:

  • the pattern and severity of the alcohol misuse (using the alcohol-use disorders test [AUDIT]) and severity of dependence (using the severity of alcohol dependence questionnaire [SADQ])

  • any treatment needs, including:

    • urgent need for assisted withdrawal

    • the presence of any comorbidities or other factors that may need further specialist assessment or intervention (for example, additional substance misuse, medical health needs such as alcohol-related liver disease, mental health needs and social problems)

  • any associated risks to the person or others (for example, self-harm, harm to others, physical or mental health emergencies, and safeguarding children).

An initial treatment plan is developed with the person, based on this assessment, considering their preferences and the outcomes of any previous treatment. [NICE's guideline on alcohol-use disorders: diagnosis, assessment and management of harmful drinking (high-risk drinking) and alcohol dependence, recommendation 1.2.2.5 and full guideline section 5.25.1, and expert opinion]

Equality and diversity considerations

The presence of stigma in healthcare settings towards people with an alcohol-use disorder in general should be considered when conducting brief triage assessments, as well as the effect of cultural factors on openly discussing alcohol-use disorders for people from some faith groups.

Some adults accessing specialist alcohol services, such as those who may lack capacity, those with a learning disability and those experiencing homelessness may benefit from the involvement of an advocate when having their needs assessed and agreeing an initial treatment plan (see NICE's guideline on advocacy services for adults with health and social care needs).