title: Development and implementation of an emergency practitioner-performed brief intervention for hazardous and harmful drinkers in the emergency department.
abstract: 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.
authors.affiliation: Section of Emergency Medicine, Yale University School of Medicine, 464 Congress Avenue, Suite 260, New Haven, CT 06519, USA. gail.donofrio@yale.edu
authors.forename: Gail
authors.initials: G
authors.lastname: D'Onofrio
authors.forename: Michael V
authors.initials: MV
authors.lastname: Pantalon
authors.forename: Linda C
authors.initials: LC
authors.lastname: Degutis
authors.forename: David A
authors.initials: DA
authors.lastname: Fiellin
authors.forename: Patrick G
authors.initials: PG
authors.lastname: O'connor
mesh_terms: 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
references.citation: Ann Emerg Med. 2002 Jul;40(1):50-62
references.pmid: 12085073
references.citation: Ann Surg. 1999 Oct;230(4):473-80; discussion 480-3
references.pmid: 10522717
references.citation: J Addict Dis. 1998;17(1):67-81
references.pmid: 9549604
references.citation: Acad Emerg Med. 1995 Sep;2(9):817-25
references.pmid: 7584769
references.citation: JAMA. 1997 Apr 2;277(13):1039-45
references.pmid: 9091691
references.citation: Ann Emerg Med. 1997 Aug;30(2):181-9
references.pmid: 9250643
references.citation: Ann Emerg Med. 1995 Aug;26(2):158-66
references.pmid: 7618778
references.citation: J Stud Alcohol. 2001 Nov;62(6):806-16
references.pmid: 11838918
references.citation: J Am Board Fam Pract. 1990 Apr-Jun;3(2):93-8
references.pmid: 2185611
references.citation: Ann Emerg Med. 2003 Jun;41(6):802-13
references.pmid: 12764335
references.citation: Ann Emerg Med. 2003 Aug;42(2):276-84
references.pmid: 12883517
references.citation: J Consult Clin Psychol. 1999 Dec;67(6):989-94
references.pmid: 10596521
references.citation: J Addict Dis. 2000;19(1):45-53
references.pmid: 10772602
references.citation: Acad Emerg Med. 2000 Jan;7(1):14-20
references.pmid: 10894237
references.citation: Ann Emerg Med. 2001 Mar;37(3):284-91
references.pmid: 11223765
references.citation: Arch Intern Med. 2001 Mar 26;161(6):895-6
references.pmid: 11268240
references.citation: J Stud Alcohol. 1993 Jul;54(4):432-40
references.pmid: 8341045
references.citation: J Trauma. 1990 Oct;30(10):1252-8
references.pmid: 2213933
references.citation: JAMA. 2001 Nov 28;286(20):2578-85
references.pmid: 11722272