SHM Converge Scientific Abstract ePoster Gallery-Evolving Practices in Alcohol Withdrawal Syndrome Management: Insights From Hospitalists Nationwide

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This mixed-methods study examined how hospitalists across the U.S. manage alcohol withdrawal syndrome (AWS) and what barriers exist to a unified approach. Thirty-three hospitalists from 27 tertiary care hospitals completed a 10-question survey, and seven virtual focus groups explored treatment strategies and challenges.<br /><br />The findings show that benzodiazepines remain the dominant treatment for AWS on medical floors, consistent with guidelines for moderate to severe withdrawal. However, phenobarbital use is increasingly common, especially in emergency departments (EDs). Survey data showed that phenobarbital protocols were reported more often in the ED than on medical floors, while benzodiazepine-based symptom-triggered therapy was more common on the floor.<br /><br />Three major themes emerged from the focus groups. First, hospitalists described AWS treatment as a “wild west” or “vibes-based” process, with providers often relying on personal training and experience rather than a standardized strategy. Second, physicians tended to prioritize outcomes such as reduced escalations, fewer restraints, and lower nursing burden when judging treatment success. Third, there was little shared decision-making with patients, and hospitals often followed a single institutional approach rather than tailoring therapy to patient preferences.<br /><br />Overall, the study highlights a disconnect between ED and inpatient management of AWS and suggests that current practice is driven more by local culture and clinician experience than by evidence-based consensus. The authors conclude that more research is needed to determine the best treatment approach, including outcomes that matter to both hospitals and patients.

Asset Subtitle

James C. Willey

Meta Tag

Author List Andrew D. Auerbach, Evan Done, James C. Willey, James D. Harrison, Jeffrey L. Schnipper, Julia E. Szymczak, Sunil Kripalani, Troy Madsen, Valerie M. Vaughn

Category Research

Concept Alcohol Withdrawal

Concept Benzodiazepines

Concept Phenobarbital

Concept Escalation of Care

Concept Mixed-Methods Research

Distinguished Non-Finalist

Presenter Organization University of Utah

Presenting Author James C. Willey

Track Other

Keywords

alcohol withdrawal syndrome

hospitalists

benzodiazepines

phenobarbital

emergency department

medical floors

mixed-methods study

treatment protocols

clinical practice variation

shared decision-making

Alcohol Withdrawal

Benzodiazepines

Phenobarbital

Escalation of Care

Mixed-Methods Research