Poster - #2022SPHU-4 - Keywords: Alcohol Withdrawal, SEWS Protocol, CIWA-Protocol, QI Project

Efficacy of SEWS Protocol Implementation – An Institutional Quality Improvement Project

Marte Furment, M.; Santharaman, A.; Raj, K.; Mohan, J. et. al
Saint Peter's University Hospital Internal Medicine Department

ABSTRACT:
INTRODUCTION: It is estimated that the cost associated with alcohol-use disorder in the United States was around $27 billion in 2010. That same year, over 1 million patients were hospitalized with alcohol-related diagnoses. To date, the Clinical Institute Withdrawal Assessment for Alcohol– Revised (CIWA-Ar) protocol is the most common method of treating Alcohol Withdrawal Syndrome (AWS). Beresford et. al. demonstrated in 2017 that the Severity of Ethanol Withdrawal Scale (SEWS) Score helps in having a better assessment on the clinical picture and helps administer earlier treatment when compared to CIWA-Ar. After changing from CIWA-Ar to SEWS protocol in our institution, we hypothesized decline in ICU admission for alcohol withdrawal complications and possibly decreased length of stay. The objective of this quality improvement project is to determine the efficacy of SEWS protocol in managing alcohol withdrawal syndrome when compared to CIWA-Ar. METHODOLOGY: We designed a SEWS protocol order set for management of non-ICU severity level of AWS. It was integrated into our electronic health record system and has been used since May 2021. Following approval of our Institutional Review Board (IRB), we obtained a list of patients who were admitted to our hospital with alcohol withdrawal from May 2020 till August 2021. We filtered a total of 53 patients who were placed on CIWA-Ar protocol and 55 patients who were placed on SEWS protocol. Patients who were admitted directly to ICU were excluded. Protocol failure was defined as need for transfer to ICU or need for an additional team’s evaluation for an adverse event in the floor related to AWS. A retrospective analysis was performed. RESULTS: Average length of stay (LOS) for patients on CIWA-Ar protocol was 4.04 days while the average length of stay for patients on SEWS protocol was 4.3 days. Protocol failure was observed in 5 out of 53 (9.4%) patients on CIWA-Ar protocol and 3 out of 55 (5.4%) patients in SEWS protocol (p value 0.593) CONCLUSION: Our study indicates that there was no statistically significant difference in length of stay between patients managed with CIWA vs SEWS protocol. It also demonstrated no statistically significant difference between failure of protocols between both groups. Despite not showing statistical difference, our institute has not received any reports of adverse incidents with patients being managed with Alcohol Withdrawal Syndrome. This we attribute to the increased confidence both from the provider and nurses administering earlier benzodiazepines and earlier detection of withdrawal symptoms by incorporating vital signs in the scoring system in SEWS protocol.