Mercer University School of Medicine, Macon, GA, USA.
Ann Emerg Med. 2013 Sep;62(3):262-6. doi: 10.1016/j.annemergmed.2013.04.011. Epub 2013 May 18.
Previous studies have shown that brief interventions for at-risk alcohol and drug use are significantly more likely to occur if patients are screened with a standardized, validated instrument, but high screening rates have traditionally been difficult to attain. Use of very brief screens can enable brief intervention specialists to focus their efforts on assessing and assisting patients most likely to need a brief intervention or more intensive treatment. This study describes the results of integrating brief substance abuse screens into an urban emergency department's (ED's) triage process.
As part of a comprehensive initiative to increase alcohol and drug screening, brief intervention, and referral to treatment (SBIRT), 3 single-item screening questions were programmed into the electronic triage tool used in the ED to detect tobacco use, at-risk alcohol use, illicit drug use, or prescription drug misuse. Project staff conducted training sessions with nurses to ensure the questions were asked properly and ED supervisors provided ongoing performance feedback. Names of patients with positive responses to the alcohol or drug questions automatically populated a list forwarded to health education specialists, who provided assessments, brief interventions, and referrals.
Screening was conducted with 145,394 of 151,597 eligible patients, a 96% screening rate. Electronic reports revealed an 89% screening rate 30 days postimplementation and gradually increasing and stabilizing at approximately 97%. The overall percentage of patients screening positive for alcohol or drug use was similar to that of other ED-based studies (22%) but varied substantially by patient demographics.
High rates of screening can be achieved if properly integrated into a clinical setting's existing patient care processes with well-planned information technology support.
之前的研究表明，如果患者使用标准化、经过验证的工具进行筛查，那么进行风险酒精和药物使用的简短干预的可能性就会大大增加，但传统上很难达到高筛查率。使用非常简短的筛查可以使简短干预专家能够集中精力评估和帮助最有可能需要简短干预或更强化治疗的患者。本研究描述了将简短药物滥用筛查纳入城市急诊部（ED）分诊流程的结果。
作为一项旨在增加酒精和药物筛查、简短干预和转介治疗（SBIRT）的综合计划的一部分，3 个单一问题的筛查问题被编程到 ED 中使用的电子分诊工具中，以检测烟草使用、风险酒精使用、非法药物使用或处方药物滥用。项目工作人员与护士一起进行了培训课程，以确保正确提出问题，ED 主管提供持续的绩效反馈。对酒精或药物问题回答为阳性的患者的姓名自动列入转发给健康教育专家的名单，健康教育专家提供评估、简短干预和转介。
对 151597 名符合条件的患者中的 145394 名进行了筛查，筛查率为 96%。电子报告显示，实施后 30 天的筛查率为 89%，并逐渐增加并稳定在 97%左右。对酒精或药物使用呈阳性筛查的患者的总体百分比与其他基于 ED 的研究相似（22%），但患者人口统计学特征差异很大。
如果将其正确整合到临床环境的现有患者护理流程中，并提供精心规划的信息技术支持，就可以实现高筛查率。
