University of Massachusetts Medical School, Worcester, MA, USA.
Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA.
J Pediatr Surg. 2022 Jan;57(1):111-116. doi: 10.1016/j.jpedsurg.2021.09.048. Epub 2021 Oct 5.
Pediatric trauma centers are required to screen patients for alcohol or other drug use (AOD), Briefly Intervene, and Refer these patients to Treatment (SBIRT) to meet Level 1 and 2 trauma center requirements set by the American College of Surgeons. We evaluated if a mandatory electronic medical record tool increased SBIRT screening compliance for all trauma and non-trauma adolescent inpatients.
A SBIRT electronic medical record tool was implemented for pediatric inpatient AOD screening. A positive screen prompted brief intervention and referral for treatment in coordination with social work and psychiatric consultants. We compared pre and post- implementation screening rates among inpatients age 12-18 years and performed sub-group analyses.
There were 873 patients before and 1,091 after implementation. Questionnaire screening increased from 0% to 34.4% (p < 0.001), without an increase in positivity rate, and lab screening decreased by 4.2% (p = 0.003). Females were more likely to receive a social work consultation than males (14.5 vs 7.5%, p < 0.001), despite a greater number of positive questionnaires among males (9.5 vs 17.9%, p = 0.013). White patients were more likely to receive a social work consultation (12.9%) compared to Asian (2%), Black (6.3%), and Other (6.9%) (p = 0.007), despite comparable rates of positive screenings. When comparing English to non-English speakers, English speakers were more likely to have a social work consult (12.0% vs 2.4%, p < 0.001) and psychiatry/psychology consult (13.6 vs 5.6%, p = 0.011).
Multidisciplinary training along with an electronic medical record tool increased SBIRT protocol compliance. Demographic disparities in intervention rates may exist.
儿科创伤中心需要对患者进行酒精或其他药物使用（AOD）筛查，进行简短干预，并将这些患者转介至治疗机构（SBIRT），以满足美国外科医师学院设定的 1 级和 2 级创伤中心要求。我们评估了强制性电子病历工具是否能提高所有创伤和非创伤青少年住院患者的 SBIRT 筛查依从性。
为儿科住院患者的 AOD 筛查实施了 SBIRT 电子病历工具。阳性筛查提示进行简短干预，并与社会工作者和精神科顾问协调进行治疗转介。我们比较了 12-18 岁住院患者实施前后的筛查率，并进行了亚组分析。
实施前有 873 例患者，实施后有 1091 例。问卷调查筛查从 0%增加到 34.4%（p<0.001），但阳性率没有增加，实验室筛查减少了 4.2%（p=0.003）。与男性相比，女性更有可能接受社会工作者咨询（14.5%比 7.5%，p<0.001），尽管男性的阳性问卷更多（9.5%比 17.9%，p=0.013）。与亚洲（2%）、黑人（6.3%）和其他族裔（6.9%）相比，白人患者更有可能接受社会工作者咨询（12.9%）（p=0.007），尽管阳性筛查率相当。与英语患者相比，非英语患者更有可能接受社会工作者咨询（12.0%比 2.4%，p<0.001）和精神科/心理学咨询（13.6%比 5.6%，p=0.011）。
多学科培训和电子病历工具提高了 SBIRT 方案的依从性。干预率方面可能存在人口统计学差异。
