title: Incorporating screening, brief intervention, and referral to treatment into emergency nursing workflow using an existing computerized physician order entry/clinical decision support system.
abstract: BACKGROUND
  The objective of this study was to evaluate whether screening, brief intervention, and referral to treatment (SBIRT) could be incorporated into the emergency nursing workflow using a computerized physician order entry/clinical decision support system. We report demographic and operational factors associated with failure to initiate the protocol and revenue collection from SBIRT.
  
  
  METHODS
  We conducted a retrospective, observational cohort analysis of a protocol adding SBIRT to the emergency nursing workflow of a single, tertiary care urban emergency department for all adult patient visits in 2012. Emergency nurses prescreened for unhealthy alcohol or drug use during triage assessment and, when positive, administered SBIRT during treatment area care, all documented in the computerized physician order entry/clinical decision support system. Using multivariable logistic regression, we report demographic and operational factors associated with failure to initiate the protocol. From October 2012, we submitted charges for brief interventions and analyzed collection results.
  
  
  RESULTS
  The inclusion criteria were met for 47,693 visits. Of these, 39,758 (83.4%) received triage protocol initiation. Variables associated with decreased odds of protocol initiation were younger age (odds ratio [OR] for rising age, 1.044; 95% confidence interval [CI], 1.042-1.045), arrival by ambulance (OR, 0.37; 95% CI, 0.35-0.40), and higher triage acuity (OR, 0.08; 95% CI, 0.07-0.09). Of visits with protocol initiation, 21.4% were documented as positive for at-risk alcohol and/or drug use. However, brief interventions were only administered during 971 visits. During the billing period, $3617.53 was collected on charges of $10,829.15 for 262 completed brief interventions.
  
  
  CONCLUSIONS
  In this study electronic documentation of adults with at-risk alcohol and/or drug use was feasible by emergency nurses, but SBIRT execution and subsequent revenue collection were challenging.
authors: Pittsburgh, PA.
authors: Tamara
authors: T
authors: Slain
authors: Pittsburgh, PA.
authors: Sherry
authors: S
authors: Rickard-Aasen
authors: Pittsburgh, PA.
authors: Janice L
authors: JL
authors: Pringle
authors: Pittsburgh, PA.
authors: Gajanan G
authors: GG
authors: Hegde
authors: Pittsburgh, PA.
authors: Jennifer
authors: J
authors: Shang
authors: Pittsburgh, PA.
authors: William
authors: W
authors: Johnjulio
authors: Pittsburgh, PA. Electronic address: avenkat@wpahs.org.
authors: Arvind
authors: A
authors: Venkat
mesh_terms: D000328:Adult; D000368:Aged; D003376:Counseling; D020000:Decision Support Systems, Clinical; D016529:Emergency Nursing; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems; D008875:Middle Aged; D009730:Nursing Assessment; D012017:Referral and Consultation; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000628:therapy*; D011795:Surveys and Questionnaires; D057188:Workflow
keywords: Alcohol; CDS; CPOE; Drug; Emergency department; Nursing; SBIRT