IMPLEMENTING SBIRT IN THE ADULT TRAMA POPULATION ADMITTED BY NORTHEAST ACUTE CARE SURGERY AT CHS NORTHEAST
Abstract
ABSTRACTMALLORY RAGAN ROYALL: Implementing SBIRT in the Acute Care Trauma Population admitted by Northeast Acute Care Surgery at Carolinas Healthcare Center Northeast. (Under the direction of DR. ALLISON BURFIELD) Background: Abuse of alcohol and illicit drugs demonstrate exponential growth each year on a national and global scale. The increasing rate of addiction is negatively disproportionate when compared to the rate of individuals seeking treatment. Patients with substance abuse are often unreached by the appropriate healthcare resources leading to many problems socially, physically, and psychologically, thus yielding high rates of death and mortality. Especially known for high rates of substance abuse are patients admitted for trauma. The Substance Abuse and Mental Health Services Administration (SAMHSA) took action on intervening with providing substance abuse screening as part of routine health care in 2003. The Screening, Brief Intervention, and Referral to Treatment (SBIRT) tool is a public health model designed to provide screening and intervention for individuals with substance abuse issues that can be used in multiple different healthcare settings. Purpose: The purpose of this project was to implement improved detection of alcohol and substance abuse through the implementation of the SBIRT screening tool in the trauma patient population admitted by Northeast Acute Care Surgery at Carolinas Healthcare System Northeast. This process has the potential to facilitate increased provider assessment and an improved mechanism for identification of alcohol use. The American College of Surgeons is requiring Level III trauma centers to demonstrate screening and intervention for trauma patients with substance abuse. This study evaluated the implementation of a protocol to assist with meeting those requirements, with the potential to improve overall patient outcomes. Methodology: The target population for this project included all patients classified as trauma alert, code I, or code II that are admitted under either observation, or inpatient status to NE ACS at CHS Northeast. The sample were a convenience sample and with no control group. The inclusion criteria included English speaking adult patients only, eighteen years and older with the exception of individuals who have a designated healthcare power of attorney due to inability to independently make health related decisions. The SBIRT screening tool defines unhealthy alcohol consumption, utilizes the AUDIT-C and AUDIT tool for screening, and suggests brief intervention conversations. The tool also screens for illicit drug abuse in which any identification of use is considered unhealthy. The patients were screened on admission and if the screen is positive received a brief intervention and referral to treatment. The patient’s score and brief intervention and/or referral to treatment was recorded and compared to rescreening data achieved at the follow up appointment, or via follow-up phone call after discharge. Results: Over a three-month time period of screening trauma patients with the SBIRT tool at CHS Northeast, 93 patients were admitted and 31 of those patients were tested and/or screened positive for alcohol abuse, drug use, or both. Five patients were considered positive for Substance Use Disorder (alcohol), 28 were positive for drug use, and 2 patients were positive for both. The age-range of positive screens was between 18 years old and 80 years old. 71% were male, 29% female. Of that population, 6% of the patients accepted referral to treatment and 6% of those patients received documentation of substance withdrawal. Patients reported their willingness to change on a scale of 0-10 with about one third of those patients rating their willingness to change at 10. Of the patients with positive screens, 6 of those refused brief intervention. Only four patients were reached for follow up, two patients remained abstinent from substance use and two patients continued to use. Of note, one of the patients that continued use of illicit drugs was reported to be for medical reasons. Unfortunately, limitations of the study included poor follow-up attributed to time frame for follow-up and a lack of reliable contact, or incorrect phone numbers. Twenty-three patients opted not to proceed with referral to treatment. Further limitations may include patient transparency regarding drug and alcohol use as most of this information is subjective. Implications: Screening for substance abuse and subsequent intervention remains a crucial need in the healthcare arena, especially the inpatient setting. A third of the patients in this study screened positively for substance abuse, therefore supporting the recommendation for screening and intervention tools to be continued in practice. In the future, the focus should be on preparing the patient with resources available to them during the single admission (referral, resources, phone numbers, treatment centers etc.) as follow-up was unreliable. The two patients that did choose referral to treatment were discharged to rehabilitation facilities. This warrants consideration for implementation of addiction services at those facilities as well. Additionally, ease of data collection and continuity of care could be improved if the screening tool is incorporated into the electronic medical record (EMR) for easy access among healthcare providers.