Excessive alcohol consumption is putting immense pressure on our hospital EDs. Video / NZ Herald / Getty
Two studies released today illustrate the burden that excessive alcohol drinking, particularly among older age groups, is putting on our strained hospital emergency departments.
Excessive alcohol consumption is putting immense pressure on hospital emergency departments (EDs), fuelling an increase in abuse and violence against staff and adding to waiting times for all patients, according to two studies released today.
More than 70 per cent of ED staff surveyed by the Australasian College for Emergency Medicine said they were regularly abused, threatened, or harassed by drunk patients, with 43.5 per cent claiming they also frequently experienced physical aggression from people under the influence of alcohol.
“Violent and abusive behaviour from intoxicated persons occurs every few hours of every shift and is exhausting,” said one clinician who responded to the survey, which is reported here for the first time.
A separate study published today in the New Zealand Medical Journal found that a quarter of people who turned up at one hospital because of excessive drinking or alcohol-related incidents had consumed more than 20 standard drinks.
Together, the studies emphasise how alcohol consumption has amplified a national crisis in EDs that has led to exploding waiting times, ambulances stuck on ramps for hours, and overworked doctors and nurses fearful about the quality and safety of the care they provide.
Researchers at the University of Otago placed medical students in the Christchurch Hospital ED for the same three-week period in 2013, 2017 and 2022.
They interviewed people who had presented at the ED after drinking or had been involved in an alcohol-related incident like a car crash or domestic violence. The research window included popular dates on the Christchurch social calendar, Cup Day and Crate Day.
Their findings reaffirmed some well-known facts: binge-drinking remains a problem in New Zealand and has a significant effect on overwhelmed EDs.
Alcohol-related presentations rose from 5 per cent in the 2013 study to 11 per cent in 2022.
“ED is not a pleasant place to be,” said Dr Laura Joyce, a senior lecturer at the university and emergency physician at Christchurch Hospital. “And EDs around the country are incredibly overcrowded … so if we could reduce that alcohol burden, that would just make life a lot nicer for the other patients in ED and the staff.”
A quarter of participants in the 2022 study had consumed at least 20 standard drinks - more than half a bottle of vodka or 15 full-strength beers. The recommended “safe” limit is two standard drinks for a female or three for a male. “This is 10 times that,” Joyce said.
Christchurch Hospital emergency physician Dr Laura Joyce says alcohol-related incidents place a great burden on busy emergency departments. Photo / University Otago
The research also upturned some assumptions around harmful drinking in New Zealand and showed changes in where and how we are consuming alcohol.
“It’s not young people drinking in pubs and bars anymore,” Joyce said. “In fact, the biggest increase we’re seeing is in the older age group.”
Alcohol presentations among patients aged 55 and older doubled between 2013 and 2022, while the rate of younger drinkers fell.
That was in line with broader cultural changes in New Zealand and overseas in which younger people were less likely to take part in risky behaviour, including drinking.
Researchers also asked participants where they purchased their alcohol from. Over the study period, a rising number of alcohol presentations had bought their drinks in a bar, pub or club before ending up in the ED.
But the majority of alcohol-related presentations (64 per cent) bought their drinks at a liquor store or supermarket and consumed them at home.
Joyce said this highlighted the need for stronger policies for off-licence venues, which were supplying large quantities of cheap alcohol and contributing to New Zealand’s drinking culture.
The rise of alcohol delivery during the Covid-19 pandemic may also have played a role in alcohol availability and excessive drinking, she said.
Christchurch Hospital's emergency department is one of the busiest in Australasia, with 130,000 presentations a year. As many as 10 per cent of those presentations could be alcohol-related.
Christchurch City Council attempted to bring in a Local Alcohol Policy which would have set new limits on where and when alcohol could be sold, but it was abandoned after repeated appeals from the industry.
A law change last year removed some of the hurdles for councils wanting to set stricter limits on alcohol sales.
In the ACEM survey, ED staff in Australia and New Zealand said the burden on their departments from alcohol-related behaviour and health issues has got worse in the past decade.
The overwhelming majority of respondents said that disruptive behaviour from people under the influence of alcohol has made them feel unsafe, added to their workloads, and created a worse environment for other patients.
The survey, conducted in August and September 2022, received responses from 1,284 ED staff in both countries. It showed that nurses are more likely to experience alcohol-related abuse than doctors and that urban hospitals are impacted more than those in rural settings.
ACEM said that EDs are bearing the brunt of a wider social issue and that addressing the problem will require sustained “whole-of-system” solutions.
It is calling for the Government to improve security in EDs, better resource alcohol and drug addiction treatment services that patients can be referred to, and expand training for staff in de-escalating aggressive behaviour. It also wants tougher controls on alcohol sales and promotion.
“Responding to alcohol-related harms is not the sole responsibility of emergency departments or even the health system,” ACEM said. “Reform and investment are required across the community to change how alcohol is consumed and to improve safety.”
Health Minister Dr Shane Reti said: “I certainly recognise that alcohol can fuel or exacerbate incidents in EDs. Excessive drinking is dangerous – both for the person drinking, and for those around them.
“I want to see continuing reductions in alcohol consumption.”
Duncan Bliss, director of programmes in the delivery unit at Health NZ, said intoxicated patients have the same right to treatment as others who arrive in EDs. However, violence, threats, and verbal abuse are increasing and “we take very seriously any behaviour that threatens or harms our people”.
Bliss also acknowledged that alcohol-related incidents are increasing waiting times.
Health NZ put 200 more security staff in EDs over the summer and says this will continue until long-term decisions are made about security. It is also taking measures to train staff in de-escalating difficult situations.
Bliss said the National Public Health Service has a “comprehensive work programme” to reduce alcohol-related harm. These include activities to “de-normalise” alcohol, remove alcohol advertising and sponsorship, and improve health literacy.
Isaac Davison is an Auckland-based reporter who covers health issues. He joined the Herald in 2008 and has previously covered the environment, politics, and social issues.
Alex Spence is a senior journalist based in Auckland. Before joining the Herald, he spent 17 years in London working for The Times, Politico, and BuzzFeed News.
