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Implementing Screening, Brief Intervention, and Referral for Alcohol and Drug Use: The Trauma Service Perspective

Sise, Michael J. MD; Sise, C Beth MSN, JD; Kelley, Dorothy M. MSN; Simmons, Charles W. MD; Kelso, Dennis J. PhD

Journal of Trauma and Acute Care Surgery: September 2005 - Volume 59 - Issue 3 - p S112-S118
doi: 10.1097/01.ta.0000176045.95492.01
Session 3

Background: Most trauma surgeons are unfamiliar with screening, brief intervention, and referral (SBIR) programs for substance use disorders, and few trauma centers provide them. This report describes how an urban private-teaching hospital adapted a protocol from an existing emergency department-based program to include patients treated by the trauma service.

Methods: We recorded the rates of SBIR completion and reasons for failure during each phase of the implementation, interviewed trauma service staff and health educators to assess attitudes toward the program, and evaluated patient satisfaction surveys.

Results: By adding SBIR staff to the trauma outpatient clinic and to trauma morning rounds, the capture rate increased from 12 to 71%. Most screened patients (59%) were found at risk for problems or probably dependent on alcohol or drugs. Trauma service staff and health educators reported high satisfaction with the program. Patients reported higher satisfaction with SBIR.

Conclusion: SBIR services can be effectively integrated into all components of a busy, urban trauma service by adding specially trained health educators to the trauma service staff. This collaboration provides effective SBIR services to both trauma and emergency service patients without interfering with patient flow or medical procedures. The relatively high percentage of patients at risk for alcohol or drug problems supports the inclusion of routine alcohol and drug screening for all eligible trauma patients.

From the Division of Trauma (M.J.S., C.B.S., D.M.K.) and Emergency Medicine (C.W.S.), Scripps Mercy Hospital, San Diego, California, and Altam Associates, San Diego, California (D.J.K.).

Submitted for publication December 21, 2004.

Accepted for publication December 21, 2004.

This article was written for the proceedings from a conference entitled “Alcohol and Other Drug Problems Among Hospitalized Trauma Patients: Controlling Complications, Mortality, and Trauma Recidivism” in Washington, DC, May 28–30, 2003. It does not reflect the official policy or opinions of the Centers for Disease Control and Prevention (CDC) or the U.S. Department of Health and Human Services (HHS) and does not constitute an endorsement of the individuals or their programs—by CDC, HHS, or the federal government—and none should be inferred.

Address for reprints: Michael J. Sise, MD, 550 Washington Street, Suite 641, San Diego, CA 92103; email:

© 2005 Lippincott Williams & Wilkins, Inc.