Alcohol screening can reduce readmissions
Alcohol screening can reduce readmissions
Free ENA tool kit introduced in 360 EDs
On April 10, 2008, 360 nurses in EDs nationwide began using the Screening, Brief Intervention and Referral to Treatment (SBIRT) program, an alcohol screening and intervention tool kit provided free by the Emergency Nurses Association (ENA).
The tool has been piloted for more than two years in several EDs and has shown impressive results. For example, a three-month follow-up in the five EDs that participated showed the following:
- Of the ED patients who received the intervention, 97.3% had no return ED visits, compared with 88.6% of those who received usual care.
- The patients in the intervention group had a 10%+ reduction in alcohol consumption compared to the control group.
"I think the program is effective because it tells you how to quantify drinking in terms of who is at risk and needs to be referred for additional treatment, and it is gender- and age-specific," explains Patricia Kunz Howard, PhD, RN, CEN, operations manager, emergency and trauma services at the University of Kentucky Chandler Medical Center in Lexington.
The program begins with a brief survey that helps define at-risk or problem drinking. "If you drink this amount [accounting for age and gender]. you have a problem. If it's negative, you don't have to do the intervention," says Howard, who helped develop the tool kit.
For patients who screen positive, there is a "brief, negotiated session with targeted information," during which the patient comes up with a rate of drinking that might represent a reasonable reduction, she says. The patient is provided with advice on how to meet that goal.
The basic components of the program were in place in 2005, when Howard put out a call for sites to do the screenings. "We wanted to see if ED nurses could do it within the constraints of a busy ED," she explains.
That turned out not to be a problem. "We were already asking ED patients about alcohol use. This just helped quantify our results," Howard explains. "These screenings are easy to do, and the whole process takes between five and seven minutes."
Based on those findings, Howard was asked to do an outcomes study to determine if using SBIRT in the ED would decrease the likelihood the patient would come back to the ED with an injury related to alcohol. "We saw that basically it does improve the likelihood the patient will reduce drinking, and it dramatically reduced repeat visits, so I was asked to develop the tool kit," she says.
The kit makes it much easier to understand SBIRT and to train the ED staff, says Wendy St. John, RN, assistant trauma nurse coordinator at Wishard Health Services in Indianapolis. St. John has been using the SBIRT process since 2005.
"The tool kit that ENA had just released is free, and it has an informational video to pass out to help train the ED staff," she says. "We had to bring medical professionals and other experts here to help with our training."
The kit also includes case studies that demonstrate different possible scenarios, St. John says.
St. John, who has personally conducted the trauma interventions at her facility, warns ED managers that even though she thinks the program is "fantastic," she has seen a wide range of reactions from patients.
"I've actually seen rage from patients in a major state of denial," she says. "Even if I just provided them with their alcohol level, they would become argumentative and refuse to believe that was the true level."
Other patients, while appreciative, would listen politely but "would probably not make a change in their lives," says St. John. However, there were those with whom she might spend as much as an hour in conversation about what got them into alcohol abuse, and they would re-evaluate the choices they needed to make in their lives. "I think the more you do these, the more comfortable you feel discussing with patients the fact that they might not be in a place in their lives to make any sort of change," says St. John. "In any event, you want to prevent getting in an argument when they are in that state."
Despite these occasional frustrations, the efficacy of the program cannot be denied. It can clearly reduce injuries and future health problems, Howard says. "Not every patient will want to change, but for a lot of people, recognizing what is at risk is a real eye-opener," she says.
SBIRT is good for ED patients, says St. John. "One of our roles as an ED nurse is to help prevent future injury," she says. St. John also is convinced the time it takes to provide the intervention is time well spent. "As long as we don't have some other ED patient in deep crisis we can and should use that time to really prevent further injury," she says.
To obtain a free copy of the ENA's SBIRT Tool Kit, go to www.ena.org.On April 10, 2008, 360 nurses in EDs nationwide began using the Screening, Brief Intervention and Referral to Treatment (SBIRT) program, an alcohol screening and intervention tool kit provided free by the Emergency Nurses Association (ENA).
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