Alcohol screening, brief intervention, and referral in the emergency department: an implementation study.

INTRODUCTION: Alcohol is the single greatest contributor to injury in the United States. Numerous studies have reported that a standardized screening, brief intervention, and referral to treatment (SBIRT) intervention can effectively minimize future alcohol consumption, reduce injury recurrence, and decrease the number of repeat ED visits. To date, SBIRT studies have been conducted in settings in which physicians or research assistants carried out SBIRT. Little is known about ED nurses carrying out SBIRT. The purpose of this study was to examine ED nurse training needs and identify both barriers to, and enablers of, SBIRT implementation in the emergency department.
METHODS: Two coordinators from each of the 5 ED sites selected for the study attended a 1-day SBIRT educational session. Site coordinators then trained their staff nurses to conduct SBIRT. Site coordinators were surveyed at the midpoint and end of the 6-month implementation study period. Patient data from each facility was collected.
RESULTS: Ten site coordinators were trained and held subsequent training sessions with nursing staff in their respective emergency departments. All sites encountered barriers to implementation, but 2 of 5 sites were able to implement the SBIRT process fully by the end of the evaluation period. A total of 3265 patients were screened for alcohol use problems. Of those screened, 678 (21%) were classified as hazardous drinkers. Overall, 56% of the positive-screened patients received 3 to 5 minutes of a brief intervention. After the brief intervention, between 9% and 82% of patients were referred for further care. DISCUSSION: The SBIRT process can be conducted successfully by emergency nurses. However, substantial operational barriers to widespread routine implementation exist. These barriers need to be addressed before emergency nurses incorporate SBIRT as routine part of ED care.