Rhode Island Hospital works with Kent Hospital as test site in study
Screening and brief interventions for identifying alcohol problems are effective, but not often used in community hospital emergency departments
Study shows positive results when SBI model was implemented in a community hospital ED, but rate of screening returned to previous levels following study
Identified barriers that, if overcome, could allow model to work in a community hospital setting
There are an estimated 7.6 million alcohol-related emergency department (ED) visits each year in the country. A first step in identifying an alcohol problem is screening all ED patients utilizing two well-researched screening tests. Once identified, one technique that has proven successful is motivationally-based brief interviews focused on reducing alcohol use. The research to date, however, has been focused on an academic medical environment and not within the more common environment of the community hospital ED, where 56 percent of all ED visits occur.
As a result, physicians and researchers at Rhode Island Hospital's Injury Prevention Center set out to identify a model that could integrate screening and brief interventions (SBI) for alcohol misuse into a community hospital environment. The study was published in the August 2009 issue of the journal Substance Abuse. Their goal was to develop, implement and evaluate the adoption of a model of SBI, using feedback from the community hospital ED. This would then allow them to create a delivery method for the toolkit for SBI developed by the American College of Emergency Physicians (ACEP) and the National Highway Traffic Safety Administration.
Under the direction of lead author Michael Mello, MD, MPH, director of the Injury Prevention Center and an emergency medicine physician at Rhode Island and The Miriam hospitals, the researchers worked with Robert Dinwoodie, DO, MBA, an emergency medicine physician at Kent Hospital as a pilot site.
The project was divided into two phases over a year. The first phase involved meeting with key stakeholders to gather information and feedback on the SBI delivery model design and implementation. The feedback was then used to adapt the proposed SBI model design for the community hospital and train the staff. Phase two focused on the implementation and adoption of the SBI into the ED setting in the community hospital over a 6-month period. The research study design team included ED physicians, a clinical psychologist, experimental psychologist and project coordinator, along with a research assistant who was present in the ED to record the extent of adoption into the ED's practice.
Mello says, "Our research identified numerous barriers, with key stakeholders expressing concern over potential disruption to the clinical practice and patient flow; the burden of SBI on staff time, particularly nurses; the willingness of nursing and physician staff to accept the SBI; and staff reluctance to speak to patients about alcohol-related issues when not directly related to a patient's chief complaint. These are all understandable concerns."
As a result, the SBI model was modified to address the concerns. The implementation was limited to an area of the ED for non-critical patients, active participation was limited to physicians only who would evaluate using the screening tool and then refer patients screening positive to a research assistant who would then perform the 5- to 10-minute brief intervention.