Uncomplicated acute alcohol intoxication in the emergency department: a 12-year retrospective study to understand practice change in intravenous fluid usage and patient outcomes

Objective: This study aimed to identify uncomplicated acute alcohol intoxication (UAAI) practice changes in two Emergency Departments (EDs) and assess if these changes correlate with the conduct of a randomized controlled trial recommending practice change. Methods: This dual-site retrospective observational cohort study used ED data over a 12-year period (2010 - 2021). The sample included patients with UAAI who presented to one health service in Australia. Changes in patient and health service outcomes were explored for UAAI ED presentations over time. Data were analysed using descriptive statistics, inferential statistics, and a monthly time series analysis. Results: There were 2344 UAAI-related presentations during the study period. The time series identified two practice change points leading to three periods of practice change. The proportion of patients who received intravenous fluids (IVFs) decreased from 45.9% to 21.7% (p < 0.001). Most patients who presented with UAAI were discharged from the ED (69.4%, n = 1627/2344). Discharged patients had a reduced median length of stay over the study periods (p < 0.001). Conclusions: Changing practice from an interventional approach for the administration of IVFs to an observation-based approach, for ED patients with UAAI is appropriate and can be sustained. This approach for the management of UAAI is supported by an established and growing evidence base. Factors regarding the reach, adoption and translation of evidence to clinical practice should be further explored.