SHM Converge Scientific Abstract ePoster Gallery-Improved Treatment Protocol for Alcohol Withdrawal Syndrome

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Medical College of Wisconsin clinicians updated the inpatient alcohol withdrawal syndrome (AWS) order set in EPIC to improve evidence-based care for patients with alcohol use disorder (AUD). The project aimed to better guide treatment after withdrawal, promote validated severity scoring, and support a multidisciplinary approach.<br /><br />Key changes included use of the Prediction of Alcohol Withdrawal Severity Scale (PAWSS) to identify patients at risk for complicated withdrawal, phenobarbital “front-loading” for higher-risk patients, a scheduled gabapentin protocol, routine thiamine for all patients, and automatic social work referral to encourage follow-up treatment for AUD.<br /><br />The rationale for these changes was based on prior evidence showing that PAWSS accurately predicts severe withdrawal, phenobarbital can reduce ICU admissions, gabapentin may shorten hospital stays and reduce benzodiazepine use, and thiamine deficiency is common in AUD. Social work referral was added because relatively few patients with AWS are discharged on FDA-approved AUD medications.<br /><br />Initial outcomes compared before and after implementation showed modest changes. Order set use was still limited, with only about 35% of AWS patients managed through the new protocol. However, phenobarbital use increased from 38.3% to 35.1% overall? More importantly, gabapentin use rose from 3.7% to 6.6%, discharge medication prescribing increased from 62.4% to 65.0%, and social work referrals increased from 57.9% to 65.0%. ICU transfers decreased slightly from 8.0% to 8.7%, and readmission rates dropped from 15.0% to 13.7%.<br /><br />Overall, the updated order set appears promising, but broader provider adoption is needed for stronger evaluation.

Asset Subtitle

Nathan R. Luzum

Meta Tag

Author List Kimberly Stoner, Nathan R. Luzum

Category Innovations

Concept Alcohol Withdrawal Syndrome

Concept PAWS

Concept Alcohol Use Disorder

Concept Risk Stratification

Concept Complicated Alcohol Withdrawal

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Nathan R. Luzum

Track Quality Improvement

Keywords

alcohol withdrawal syndrome

alcohol use disorder

EPIC order set

PAWSS

phenobarbital

gabapentin

thiamine

social work referral

evidence-based care

inpatient treatment

Alcohol Withdrawal Syndrome

PAWS

Alcohol Use Disorder

Risk Stratification

Complicated Alcohol Withdrawal