Screening, Brief Intervention and Referral to Treatment in an Emergency Room

Abstract

Background: Alcohol and substance use are leading causes of hospitalizations, injury and death. Individuals increasingly use the emergency room to seek help for their alcohol and substance use related concerns. The purpose of this quality improvement project was to implement a Screening, Brief Intervention and Referral to Treatment intervention (SBIRT) to effectively evaluate at-risk or current individuals with alcohol or substance use in a high-volume emergency room in rural Maryland. Methods: The project was implemented over a 12-week period and included every adult 18 years and older with alcohol or substance use related concerns. All encounters were screened by the Behavioral Health Response Team (BHRT) using the Cut, Annoyed, Guilty, Eye (CAGE) screening tool. The Brief Intervention (BI) included Motivational Interviewing (MI) and was elicited with individuals scoring a 2 or higher on the CAGE screening. Individuals were asked their readiness to change score post-MI intervention. All encounters were referred or given information to access inpatient or outpatient substance use treatment facilities for the next level of care. An Excel spreadsheet and monthly run charts were performed to analyze trends towards percentages of patients receiving motivational interviewing, referrals to treatment and completed SBIRTs. Results: There were 54 (62.7%) males compared to 32 (37.3%) females that completed the SBIRT protocol. The number of individuals who completed the SBIRT process was 86 out of 112 who were eligible (76.7%), a noted increase from the internal data indicating evidence of 54.0% that were properly enrolled in treatment. Conclusion: Successful systematic implementation of an SBIRT can increase access to substance use programs, increase engagement and readiness to change and improve better outcomes in recovery management.