The “Serial Inebriate Program”The “Serial Inebriate Program”

The Impact of Dozens of Frequent Utilizers of the The Impact of Dozens of Frequent Utilizers of the EMS System and the Emergency Departments EMS System and the Emergency Departments

each day continues in Dallas Countyeach day continues in Dallas County

……and emergency and hospital resources and emergency and hospital resources continue to be distracted toward frequent continue to be distracted toward frequent usersusers

The San Diego Effort: The San Diego Effort: Dunford JV. Dunford JV. Annals of Emergency Annals of Emergency

Medicine Medicine 2006; 47:328-3362006; 47:328-336

The Serial Inebriate ProgramThe Serial Inebriate Program

San Diego set up a program to identify San Diego set up a program to identify the Individualsthe Individuals

placing the greatest burdenplacing the greatest burdenon the community due toon the community due to

unrelenting substance abuseunrelenting substance abuse

ChallengesChallenges

In California it is a misdemeanor to be In California it is a misdemeanor to be publicly intoxicated.publicly intoxicated.

Using this authorization, the program Using this authorization, the program brings persons charged four times in a brings persons charged four times in a

month month into the programinto the program

The Authorizing StatuteThe Authorizing Statute

Website: www.sandiego.gov/sipWebsite: www.sandiego.gov/sip

Participating AgenciesParticipating Agencies

Summary of the Problem - the impact Summary of the Problem - the impact of 529 specifically identified individuals of 529 specifically identified individuals with >5 visits/month to sobering center with >5 visits/month to sobering center

over 4 year periodover 4 year period

Cost Savings to San DiegoCost Savings to San Diego

•409 (77%) amassed 3,318 Emergency Department visits409 (77%) amassed 3,318 Emergency Department visits•217 (41%) required 652 hospital admissions217 (41%) required 652 hospital admissions•Resulting in 3,361 inpatient daysResulting in 3,361 inpatient days•Experience from 2000 -2003Experience from 2000 -2003•308 (58%) were transported by EMS 2,335 times308 (58%) were transported by EMS 2,335 times•Health care charges totaled $17.7 millionHealth care charges totaled $17.7 million•Payments for only 18% of charges were receivedPayments for only 18% of charges were received

The Cost to the Community in The Cost to the Community in San Diego before the SIPSan Diego before the SIP

A subsequent study revealed a 50 percent reduction in use of emergency resources by this population through

the Serial Inebriate Program

A subsequent study revealed a 50 percent reduction in use of emergency resources by this population through

the Serial Inebriate Program

Cost Savings in San DiegoCost Savings in San Diegothrough the SIPthrough the SIP

Current Efforts toCurrent Efforts toAdvance the Development ofAdvance the Development ofThe Serial Inebriate ProgramThe Serial Inebriate Program

in Dallas, Texasin Dallas, Texas

Available Data sets Available Data sets for SIP Cross-linkingfor SIP Cross-linking

ArrestsArrestsEMS Responses and EMS Responses and

TransportsTransportsED and Psych VisitsED and Psych Visits

Setting up a SIP in DallasSetting up a SIP in Dallas

Arrests OverArrests OverA One-YearA One-Year

PeriodPeriod

The Continuing Burden of Services The Continuing Burden of Services that Certain Patients Requirethat Certain Patients Requireis Enormous and Expensiveis Enormous and Expensive

This ongoing massive use of This ongoing massive use of emergency services is a very emergency services is a very

real system problemreal system problem

The Problem Patient The Problem Patient

Escalation Escalation is the ruleis the rule

A Single Patient Presenting to Our EMS SystemA Single Patient Presenting to Our EMS SystemCurrent EMS Responses and TransportsCurrent EMS Responses and Transports

The Same Individual at One Area HospitalThe Same Individual at One Area HospitalThe # of ED Visits Sept to October 2011 For Substance Abuse Issues The # of ED Visits Sept to October 2011 For Substance Abuse Issues

14 in September

13 in October

23 ED uses at 23 ED uses at one hospital alone!!!one hospital alone!!!

The Same Patient’s Blood Alcohol LevelsThe Same Patient’s Blood Alcohol Levels(note the increasing frequency of ED visits (note the increasing frequency of ED visits

with severe alcohol intoxication)with severe alcohol intoxication)

The Same Patient’s Blood Alcohol LevelsThe Same Patient’s Blood Alcohol Levels(note the increasing frequency of ED visits (note the increasing frequency of ED visits

with severe alcohol intoxication)with severe alcohol intoxication)

Sample Patient’s Presenting ComplaintsSample Patient’s Presenting Complaintsfor the last two monthsfor the last two months

Sample Patient’s Presenting ComplaintsSample Patient’s Presenting Complaintsfor the last two monthsfor the last two months

Estimates of Total ChargesEstimates of Total Charges

Average EMS Bill = $1,000Average EMS Bill = $1,000Average ED Bill = $2,000Average ED Bill = $2,000

Estimates of Total ChargesEstimates of Total Charges13 EMS Transports = $13,00013 EMS Transports = $13,000

23 ED Uses = $26,00023 ED Uses = $26,000

Total Emergency Use = $39,000Total Emergency Use = $39,000in Two Months Alonein Two Months Alone

Annual Community BurdenAnnual Community Burdenof ~ $250,000!!!!of ~ $250,000!!!!

And Additional Burdens…And Additional Burdens…These are EMS Responses thatThese are EMS Responses that

might have been saving a life for a might have been saving a life for a member of the communitymember of the community

The hundreds of ED beds being taken up The hundreds of ED beds being taken up PER YEAR amounting to thousands of hours PER YEAR amounting to thousands of hours

of ED occupancy by of ED occupancy by ONE PERSON ONE PERSON

due solely to substance abusedue solely to substance abuse

Elsewhere in TexasElsewhere in Texas

The San Antonio SIPThe San Antonio SIPLeon EvansLeon Evans

Efforts Underway in DallasEfforts Underway in Dallas

Gaining IRB approval to bring the available Gaining IRB approval to bring the available databases together for studydatabases together for study

Identifying participating agencies Identifying participating agencies

Looking for potential additional Looking for potential additional funding sourcesfunding sources

Existing Resources in DallasExisting Resources in Dallas

Dallas Police DepartmentDallas Police DepartmentCrisis Intervention TeamCrisis Intervention Team

Dallas County CorrectionsDallas County CorrectionsJudicial SystemJudicial System

The Salvation ArmyThe Salvation ArmyThe BridgeThe Bridge

Dallas Fire/RescueDallas Fire/RescueParkland Hospital/ UT SouthwesternParkland Hospital/ UT Southwestern

DCHD COPC ClinicsDCHD COPC ClinicsPsychiatric UnitsPsychiatric Units

The Challenge:The Challenge: Finding a More Finding a More

Definitive Intervention for Definitive Intervention for the Chronic Inebriate whilethe Chronic Inebriate while

Protecting our Valuable Protecting our Valuable but Limited Resourcesbut Limited Resources

Thank You!!Thank You!!

melanie.lippmann@utsouthwestern.edumelanie.lippmann@utsouthwestern.edu