Development and implementation of an emergency practitioner-performed brief intervention for hazardous and harmful drinkers in the emergency department.
OBJECTIVE
1) To develop and teach a brief intervention (BI) for "hazardous and harmful" (HH) drinkers in the emergency department (ED); 2) to determine whether emergency practitioners (EPs) (faculty, residents, and physician associates) can demonstrate proficiency in the intervention; and 3) to determine whether it is feasible for EPs to perform the BI during routine clinical care.


METHODS
The Brief Negotiation Interview (BNI) was developed for a population of HH drinkers. EPs working in an urban, teaching hospital were trained during two-hour skills-based sessions. They were then tested for adherence to and competence with the BNI protocol using standardized patient scenarios and a checklist of critical components of the BNI. Finally, the EPs performed the BNI as part of routine ED clinical care in the context of a randomized controlled trial to test the efficacy of BI on patient outcomes.


RESULTS
The BNI was developed, modified, and finalized in a manual, based on pilot testing. Eleven training sessions with 58 EPs were conducted from March 2002 to August 2003. Ninety-one percent (53/58) of the trained EPs passed the proficiency examination; 96% passed after remediation. Two EPs left prior to remediation. Subsequently, 247 BNIs were performed by 47 EPs. The mean (+/- standard deviation) number of BNIs per EP was 5.28 (+/- 4.91; range 0-28). The mean duration of the BNI was 7.75 minutes (+/- 3.18; range 4-24).


CONCLUSIONS
A BNI for HH drinkers can be successfully developed for EPs. EPs can demonstrate proficiency in performing the BNI in routine ED clinical practice.
D'Onofrio
Gail
G
Section of Emergency Medicine, Yale University School of Medicine, 464 Congress Avenue, Suite 260, New Haven, CT 06519, USA. gail.donofrio@yale.edu
Pantalon
Michael V
MV
Degutis
Linda C
LC
Fiellin
David A
DA
O'connor
Patrick G
PG
D000437:Alcoholism / Q000628:therapy*; D001291:Attitude of Health Personnel; D001521:Behavior Therapy / Q000193:education / Q000379:methods; D003237:Connecticut; D003376:Counseling / Q000193:education* / Q000379:methods*; D004502:Education, Medical, Continuing / Q000379:methods; D004521:Educational Measurement / Q000379:methods; D004635:Emergency Medicine / Q000193:education* / Q000379:methods*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D009042:Motivation; D010043:Outcome and Process Assessment, Health Care; D010865:Pilot Projects; D011446:Prospective Studies
Ann Emerg Med. 2002 Jul;40(1):50-62
12085073
Ann Surg. 1999 Oct;230(4):473-80; discussion 480-3
10522717
J Addict Dis. 1998;17(1):67-81
9549604
Acad Emerg Med. 1995 Sep;2(9):817-25
7584769
JAMA. 1997 Apr 2;277(13):1039-45
9091691
Ann Emerg Med. 1997 Aug;30(2):181-9
9250643
Ann Emerg Med. 1995 Aug;26(2):158-66
7618778
J Stud Alcohol. 2001 Nov;62(6):806-16
11838918
J Am Board Fam Pract. 1990 Apr-Jun;3(2):93-8
2185611
Ann Emerg Med. 2003 Jun;41(6):802-13
12764335
Ann Emerg Med. 2003 Aug;42(2):276-84
12883517
J Consult Clin Psychol. 1999 Dec;67(6):989-94
10596521
J Addict Dis. 2000;19(1):45-53
10772602
Acad Emerg Med. 2000 Jan;7(1):14-20
10894237
Ann Emerg Med. 2001 Mar;37(3):284-91
11223765
Arch Intern Med. 2001 Mar 26;161(6):895-6
11268240
J Stud Alcohol. 1993 Jul;54(4):432-40
8341045
J Trauma. 1990 Oct;30(10):1252-8
2213933
JAMA. 2001 Nov 28;286(20):2578-85
11722272