What are the criteria for discharging a patient with alcohol withdrawal?

Criteria for Discharging a Patient with Alcohol Withdrawal

Patients with alcohol withdrawal can be safely discharged when they have stable vital signs, resolution of withdrawal symptoms (CIWA-Ar score <8), no complications requiring inpatient care, and a comprehensive follow-up plan in place. 1

Assessment Before Discharge

• Ensure complete resolution of withdrawal symptoms using validated tools like the CIWA-Ar scale, with scores consistently below 8 indicating mild or resolved withdrawal 1
• Verify stable vital signs with no tachycardia, hypertension, or fever for at least 24 hours 1, 2
• Confirm absence of complications such as seizures, hallucinations, or delirium tremens 1, 3
• Assess for adequate hydration and electrolyte balance 2, 4
• Screen for psychiatric comorbidities that may require specialized follow-up care 1

Medication Considerations

• If benzodiazepines were used for withdrawal management, ensure the patient has completed the prescribed course (typically 5-7 days) or has been appropriately tapered 5, 6
• For patients with hepatic dysfunction who received short-acting benzodiazepines (lorazepam, oxazepam), verify medication has been appropriately discontinued 1
• Ensure the patient has received adequate thiamine supplementation (100-300 mg/day) and has a prescription to continue for 2-3 months post-discharge 1, 2
• Consider prescribing medication for relapse prevention (naltrexone, acamprosate, or baclofen) only after complete detoxification, not during active withdrawal 5, 7

Discharge Planning Protocol

• Begin discharge planning at least 24-48 hours before anticipated discharge 1, 7
• Provide a written medication schedule with clear instructions on any remaining benzodiazepine taper if applicable 6
• Supply medications adequate to last until the first post-discharge appointment 1, 7
• Schedule follow-up appointments with both primary care and addiction specialists within 1 week of discharge 4, 7
• Provide written educational materials about alcohol use disorder and its complications 3, 4
• Arrange referrals to outpatient treatment programs and support groups 1, 7

Documentation Requirements

• Complete a comprehensive discharge summary including:
  • Current medication list with dosages and schedule 1, 7
  • Recent vital signs and CIWA-Ar scores 1
  • Follow-up appointment details 1, 7
  • Warning signs that should prompt immediate medical attention 2, 4
  • Contact information for emergency services and addiction resources 3, 4

Special Considerations

• For patients with history of severe withdrawal (seizures, delirium tremens), consider longer observation periods before discharge 1
• Patients with significant psychiatric comorbidities should have psychiatric follow-up arranged prior to discharge 1
• Assess social support and living situation; unstable housing may warrant social work consultation and additional resources 3, 4
• For patients with liver disease, ensure they have appropriate hepatology follow-up 1

Common Pitfalls to Avoid

• Discharging patients too early while still at risk for withdrawal complications 2, 3
• Failing to provide adequate benzodiazepine taper instructions, risking recurrent withdrawal 6
• Neglecting to arrange timely follow-up care, which increases risk of relapse and readmission 4, 7
• Overlooking concurrent substance use disorders that may complicate recovery 1
• Prescribing benzodiazepines for longer than necessary (beyond 7-14 days), which increases risk of dependence 1, 5