An evidence based alcohol screening, brief intervention and referral to treatment (SBIRT) curriculum for emergency department (ED) providers improves skills and utilization.
OBJECTIVE
Emergency Departments (EDs) offer an opportunity to improve the care of patients with at-risk and dependent drinking by teaching staff to screen, perform brief intervention and refer to treatment (SBIRT). We describe here the implementation at 14 Academic EDs of a structured SBIRT curriculum to determine if this learning experience improves provider beliefs and practices.


METHODS
ED faculty, residents, nurses, physician extenders, social workers, and Emergency Medical Technicians (EMTs) were surveyed prior to participating in either a two hour interactive workshops with case simulations, or a web-based program (www.ed.bmc.org/sbirt). A pre-post repeated measures design assessed changes in provider beliefs and practices at three and 12 months post-exposure.


RESULTS
Among 402 ED providers, 74% reported < 10 hours of prior professional alcohol-related education and 78% had < 2 hours exposure in the previous year. At 3-month follow-up, scores for self-reported confidence in ability, responsibility to intervene, and actual utilization of SBIRT skills all improved significantly over baseline. Gains decreased somewhat at 12 months, but remained above baseline. Length of time in practice was positively associated with SBIRT utilization, controlling for gender, race and type of profession. Persistent barriers included time limitations and lack of referral resources.


CONCLUSIONS
ED providers respond favorably to SBIRT. Changes in utilization were substantial at three months post-exposure to a standardized curriculum, but less apparent after 12 months. Booster sessions, trained assistants and infrastructure supports may be needed to sustain changes over the longer term.
Bernstein
Edward
E
Department of Emergency Medicine, Boston University School of Medicine, Dowling 1 South, One Boston Medical Center Place, Boston, MA 02118, USA. ebernste@bu.edu
Bernstein
Judith
J
Feldman
James
J
Fernandez
William
W
Hagan
Melissa
M
Mitchell
Patricia
P
Safi
Clara
C
Woolard
Robert
R
Mello
Mike
M
Baird
Janette
J
Lee
Christina
C
Bazargan-Hejazi
Shahrzad
S
Broderick
Kerry
K
Laperrier
Kathryn A
KA
Kellermann
Arthur
A
Wald
Marlena M
MM
Taylor
Robert E
RE
Walton
Kim
K
Grant-Ervin
Michelle
M
Rollinson
Denise
D
Edwards
David
D
Chan
Theodore
T
Davis
Dan
D
Buchanan Marshall
Jean
J
Aseltine
Robert
R
James
Amy
A
Schilling
Elizabeth
E
Abu-Hasaballah
Khamis
K
Baumann
Brigitte M
BM
Boudreaux
Edwin D
ED
Maio
Ronald F
RF
Cunningham
Rebecca M
RM
Murrell
Teresa
T
Doezema
David
D
Anglin
Deirdre
D
Eliassen
Adriana
A
Martin
Marcus
M
Pines
Jesse
J
Buchanan
Leslie
L
Turner
James
J
D'Onofrio
Gail
G
Degutis
Linda C
LC
Owens
Patricia
P
D000437:Alcoholism / Q000628:therapy; D003479:Curriculum; D004493:Education; D004635:Emergency Medicine / Q000193:education*; D019317:Evidence-Based Medicine / Q000379:methods*; D006282:Health Personnel / Q000193:education*; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D011361:Professional Competence; D011614:Psychotherapy, Brief; D012017:Referral and Consultation