Strategy Survival Guide

Collecting data - Surveys
In Practice 1: SU Alcohol Misuse Project
Studies of a small number of hospital Accident and Emergency Departments have suggested that alcohol is
associated with a large number of visits, particularly at weekends, but there has been no well-validated nationally
representative study of the burden imposed by alcohol on A&E services. To address this gap, the alcohol project
commissioned two surveys.
Study 1: The first was a questionnaire-based survey contracted through the Health Development Agency to MORI.
This cross-sectional survey covered all 224 A&E departments in England. This was designed broadly to replicate the
first such survey in 1997. As coverage was intended to be 100%, sampling issues were not raised. The aim was to
quantify use of different procedures for recording and handling alcohol-related cases (coding schemes, diagnostic
categories, types of intervention), the perceived prevalence of such cases, the major difficulties posed by such
cases, and to identify possible future improvements to provision. The questionnaire was sent to one clinical director
and one nursing director in each department. Initial response rates both in 1997 and 2002 were around 20%, as
expected. Non-respondents were subsequently contacted directly by telephone, raising the response rate to 61%.
Study 2: The second survey was a single 24-hour "census" of a nationally representative sample of A&E
departments on a fixed date. This was designed to test three hypotheses:
• Alcohol related A&E attendances will be associated with violence and assault incidents
• Regional variations in alcohol-related A&E attendances will be related to regional general population
prevalence of excessive drinking and alcohol misuse
• Higher levels of alcohol-related A&E attendances will be associated with higher levels of violent incidents
towards A&E staff
This survey was commissioned from a leading authority in a major medical school. Sampling was based on the need
to test for a statistically significant difference in the prevalence of alcohol-related A&E attendances by men between
the regions of England. The desired sample size of cases in each region was estimated on the assumption that in
each region the proportion of A&E cases which were alcohol-related would be similar to the prevalence of excessive
drinking by men reported in the year 2000 General Household Survey. The maximum regional prevalence was 25%,
the minimum 17%.
To detect a significant difference between two independent proportions, the required number of cases in each
population was estimated using a sampling formula. This was done by the survey specialist advising the team.
A&E departments were selected by random sampling from the national list stratified by the 9 Government Office
Regions and by urban/rural catchment area. The survey was planned to be undertaken through direct interview by
research nursing staff trained specifically for this purpose. The questions were designed to establish:
• whether alcohol has been consumed in the past 24 hours
• where and when the last drink was consumed
• whether the attendance was related to a violent incident
• whether the patient had been a victim of violence or not
• where and when the violent incident had occurred
• any category of criminal offence related to the attendance
• whether an injury has been sustained and if so the nature of the injury
• reported hazardous drinking in the past year using an established questionnaire anonymised to protect
confidentiality
A breath sample indicating alcohol level was included to provide an objective assessment of alcohol intoxication.
Each A&E department was asked to report any verbally or physically violent incidents in A&E during the 24hr census
period.
Studies 1 and 2 were linked in that the second survey’s breath test measurements were intended to validate staff
perceptions of the prevalence of alcohol-related cases as determined by the first survey. However, study 2 was not
solely a validation exercise.
Hospitals are in many respects autonomous. Research surveys of patients generally required the permission of
hospital ethics committees. Ethics committees often raised issues about the proposed studies including concerns
about whether individual respondents can be identified from data records, and the preservation of respondents’
confidentiality. This process took considerable time and needed to be factored into the research commissioning
process. Where several hospitals were involved, as in the case of the second survey, multiple centre research ethics
committee (MREC) permission was sought to avoid the need to approach each hospital separately, which could have
taken considerable time.
Strategy Survival Guide – Strategy Skills
Page 124