Implementation of a Screening, Brief Intervention, and Referral to Treatment Program Using the Electronic Medical Record in a Pediatric Trauma Center

Abstract

The purpose of this project was to develop and implement a consistent process for (1) screening adolescents by history for alcohol and substance abuse and (2) providing a motivational interview for change and appropriate referrals as needed. In the 18 months since we implemented the program, 534 patients were eligible for screening. Of these, 442 actually underwent screening and of these, 32 screened positive, thus receiving a brief intervention by social work and referral for further treatment. Use of the electronic medical record was key to the implementation and sustainability of this project.

Technology Use for Alcohol Screening and Referral to Treatment

“…Three were qualitative analyses, which included a review of data elements required in the EHR to effectively screen patients and a study that wanted to understand attitudes towards screening. [25][26][27] Two were QI studies that described projects to improve the screening process, 24,28 and two were quasi-experiments on systemizing the screening process. 9,23 Lastly, one observational study evaluated EHR workflow (Table 1).…”

“…Because of its ubiquitous use and acceptance by both patients and clinicians (eg, email, phone calls, and video and text messages), it is a believed that technology helps improve clinical outcomes 29,30 . All eight studies focused on using EHRs to systemize the screening and intervention process; however, in all of the studies, a theme around “workflow” barriers was either explicitly stated or implied 9,23–29 . In the future, more attention is needed on the workflow process when integrating the SBIRT process into the EHR and clinical care.…”

“…Eight articles were included in the final analysis 9,21–29 . All studies selected evaluated the use of EHR in the AUD SBIRT process.…”

“…A qualitative study explored the knowledge and attitudes of providers to gain a nuanced understanding of providers' attitudes towards substance use. 26 Focus groups were used to understand the barriers and facilitators to SBIRT. One of the themes to emerge as part of this review was using the EHR to implement SBIRT.…”

Impact of a Rounding Tool and Clinical Champion on Trauma Patient Screening, Brief Intervention, and Referral to Treatment for Alcohol Use Disorder

“…Our clinical champion also led the development and application of another facilitator of SBIRT implementation—infrastructure change through modification of the EMR (Greenhalgh et al, 2004; McKenna et al, 2013; Palacio et al, 2020). The SBIRT champion spent extensive time with hospital-based IT professionals to add the alcohol use disorder screening questions to the nurses' intake history in a minimally disruptive manner to nurses' workflow.…”