Alcohol, cognitive impairment and the hard to discharge acute hospital inpatients

To examine the role of alcohol and alcohol-related cognitive impairment in the clinical presentation of adults in-patients less than 65 years who are 'hard to discharge' in a general hospital.

Retrospective medical file review of inpatients in CUH referred to the discharge coordinator between March and September 2006.

Of 46 patients identified, the case notes of 44 (25 male; age was 52.2 +/- 7.7 years) were reviewed. The average length of stay in the hospital was 84.0 +/- 72.3 days and mean lost bed days was 15.9 +/- 36.6 days. The number of patients documented to have an overt alcohol problem was 15 (34.1%). Patients with alcohol problems were more likely to have cognitive impairment than those without an alcohol problem [12 (80%) and 9 (31%) P = 0.004]. Patients with alcohol problems had a shorter length of stay (81.5 vs. 85.3 days; t = 0.161, df = 42, P = 0.87), fewer lost bed days (8.2 vs. 19.2 days; Mann-Whitney U = 179, P = 0.34) and no mortality (0 vs. 6) compared with hard to discharge patients without alcohol problem.

Alcohol problems and alcohol-related cognitive impairment are hugely over-represented in acute hospital in-patients who are hard to discharge. Despite these problems, this group appears to have reduced morbidity, less lost bed days and a better outcome than other categories of hard to discharge patients. There is a need to resource acute hospitals to address alcohol-related morbidity in general and Wernicke-Korsakoff Syndrome in particular.