Development and Implementation of an Emergency Practitioner-Performed Brief Intervention for Hazardous and Harmful Drinkers in the Emergency Department

Abstract

Objectives: 1) To develop and teach a brief intervention (BI) for ''hazardous and harmful'' (HH) drinkers in the emergency department (ED); 2) to determine whether emergency practitioners (EPs) (faculty, residents, and physician associates) can demonstrate proficiency in the intervention; and 3) to determine whether it is feasible for EPs to perform the BI during routine clinical care. Methods: The Brief Negotiation Interview (BNI) was developed for a population of HH drinkers. EPs working in an urban, teaching hospital were trained during two-hour skills-based sessions. They were then tested for adherence to and competence with the BNI protocol using standardized patient scenarios and a checklist of critical components of the BNI. Finally, the EPs performed the BNI as part of routine ED clinical care in the context of a randomized controlled trial to test the efficacy of BI on patient outcomes. Results: The BNI was developed, modified, and finalized in a manual, based on pilot testing.

Developing and Implementing a Multispecialty Graduate Medical Education Curriculum on Screening, Brief Intervention, and Referral to Treatment (SBIRT)

“…A more extensive evaluation of the effectiveness of our program is underway. We have been measuring SBIRT knowledge before and after training using standardized surveys that have been used in prior studies (21,36,55,56). We also have been collecting recorded samples of the residents' BNI performance within standardized patient encounters pre-and posttraining.…”

“…We anticipated that residents would be most concerned about patients who were resistant to changing their alcohol or other drug use. To address this motivational enhancement challenge, the curriculum included specific instruction and practice of strategies to engage patients with little motivation or commitment to change their alcohol or other drug use (36). Finally, at the system level, we recognized that each program had different approaches to medical education and time allotted to didactic and case based teaching.…”

“…To address this need, members of our SBIRT core senior faculty previously developed and implemented brief intervention curricula using standardized patient scenarios for practitioners in the emergency department (36) and for medical students (27). Trainee's knowledge and skills in SBIRT increased after participation in these curricula (27,37), demonstrating that brief intervention can be effectively taught to medical trainees.…”

“…The residents were then introduced to the Brief Negotiation Interview (BNI). The BNI, a type of brief intervention, is a manual-guided 5-step interviewing technique to reduce alcohol and other drug use among patients presenting in medical settings (25,36,37,50). The BNI included instruction on how to raise the subject of alcohol and drug consumption, provide feedback on the patient's drinking and drug use levels, enhance motivation to reduce or stop drinking and drug use, and negotiate and advise a plan of action.…”

Challenges Applying Alcohol Brief Intervention in Diverse Practice Settings: Populations, Outcomes, and Costs

“…The purpose of this study was to develop and test a BI, namely, the Brief Negotiation Interview (BNI), on harmful and hazardous drinkers performed by existing staff (D'Onofrio et al, 2005b). Emergency practitioners (EPs) were defined as senior emergency medicine residents, faculty, and physician associates.…”