Lean thinking is a methodology that can improve triage acuity level-3 patient flow in the ED, resulting in better throughput along with reduced waiting time.
Background: Addressing alcohol harm in prisons can potentially reduce the risk of re-offending, and costs to society, whilst tackling health inequalities. Health savings of £4.3 m and crime savings of £100 m per year can be a result of appropriate alcohol interventions. Prison therefore offers an opportunity for the identification, response and/or referral to treatment for those male remand prisoners who are consuming alcohol above recommended levels. There is however, limited evidence for the effectiveness, optimum timing of delivery, recommended length, content, implementation and economic benefit of Alcohol Brief Interventions (ABI) in the prison setting for male remand prisoners. As part of the PRISM-A study, we aimed to explore the 'elements' of an acceptable ABI for delivery, experiences of engagement with services/health professionals about alcohol use, alongside barriers and facilitators to implementation within the prison setting for male remand prisoners. Materials and methods: Twenty-four in-depth interviews were conducted with adult male remand prisoners at one Scottish prison (n = 12) and one English prison (n = 12). A focus group at each of the prison sites was held with key stakeholders (e.g. prison nurses, prison officers, voluntary alcohol/addiction services, health service managers and commissioners). Thematic analysis techniques utilizing NViVo 10 were employed. Results: A thematic content analysis of the interviews consistently highlighted that the majority of prisoners reflected about the connection between alcohol consumption and criminal offending, particularly in relation to offenses involving physical assaults. They also expressed motivation to change their alcohol consumption. Both prisoner interviews and focus groups with stakeholders (N = 2), indicated the value of continuous follow-up support outside of the prison system and also the need to address the lack of stable social environments, which is often associated with alcohol and drug consumption. Stakeholders further identified organizational barriers to the delivery of ABI, such as limited funding and manageable workloads. Conclusions: The importance of interpersonal trust indicated that intervention delivery by external organizations and nurses were favored in comparison to intervention delivery by prison staff and peer-prisoners. A2 Does perceived risk of harm mediate the effects of a primary care alcohol screening and brief advice intervention for adolescents?
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