ObjectiveAlcohol-related admissions are increasing. A significant number of these admissions are attributable to a small number of complex patients with other comorbidities who do not engage well with mainstream services. Assertive outreach teams have been used in the field of psychiatry to engage patients who are poorly compliant. This study examines whether an alcohol assertive outreach team (AAOT) can engage with this group and reduce hospital admissions.DesignThe AAOT is a multidisciplinary team with medical, psychiatric, substance misuse, psychology, nursing and social work specialists. The team worked with patients with the highest number of alcohol-related admissions and case managed in a community setting for 6 months. The admission and emergency department attendances of the cohort were compared for the 3-month period before and after the intervention. Christo inventory for substance misuse services (CISS) scores were determined pre and post the intervention period.Results54 patients were case managed. The total number of admissions in 3 months fell from 151 prior to the intervention period to 50 following the intervention. Emergency department attendances also fell from 360 in 3 months to 146 following the intervention period. CISS scores fell from 11 preintervention to eight postintervention.ConclusionsAn AAOT model appears to reduce hospital admissions and emergency department attendances in a complex group of patients that display high alcohol-related admissions.

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Salford Royal NHS Foundation Trust has developed Sand implemented a strategy to reduce the number of incidents of violence, aggression and antisocial behaviour in its emergency department. The strategy, which includes the introduction of a nurse co-ordinator role and withdrawal of treatment from persistent offenders, has ensured the care environment is safer and calmer for patients and staff. This article discusses different aspects of the strategy and the ethics of withdrawing care from patients.