Alcohol Screening, Brief Intervention, and Referral in the Emergency Department: An Implementation Study

Purpose: This pilot study examined the feasibility of implementing Alcohol Screening, Brief Intervention, and Referral (SBIRT) in the emergency department setting.

Description: A “train the trainer” approach was used to train nurses in five diverse emergency departments to screen all eligible patients age 18 and older who presented to the emergency department between April 1 and August 31, 2005. A process evaluation was conducted to examine barriers and enablers to ED SBIRT implementation.

Method: Patient data consisted of the number of patients screened for alcohol use, those who identified as at-risk through CAGE and received a brief intervention, and those who received referrals. Process data was collected at 3-month intervals using a 15-item questionnaire.

Results: A total of 3,265 patients were screened for alcohol use. Of those, a total of 678 (21%) were identified as hazardous drinkers. Of those ED patients who screened positive, an average of 58% received the brief intervention and 39% were referred for services. Insufficient time to train staff and the need for more practice were reported as the greatest sources of dissatisfaction, followed by the lack of administrative support and staff overload and time constraints.

Conclusions: Site coordinators and staff members were successful in collecting and reporting patient data and helping to advance ED SBIRT. Flexible and diverse staff training opportunities are important to the implementation and maintenance of ED SBIRT.