A Quality Improvement Initiative for Designing and Implementing a Military Service Screening Tool for a Community Emergency Department

Assessing screening, brief intervention, and referral to treatment (SBIRT) compliance and disparities for pediatric inpatients at a tertiary care facility

BACKGROUND

Pediatric trauma centers are required to screen patients for alcohol or other drug use (AOD), Briefly Intervene, and Refer these patients to Treatment (SBIRT) to meet Level 1 and 2 trauma center requirements set by the American College of Surgeons. We evaluated if a mandatory electronic medical record tool increased SBIRT screening compliance for all trauma and non-trauma adolescent inpatients.

METHODS

A SBIRT electronic medical record tool was implemented for pediatric inpatient AOD screening. A positive screen prompted brief intervention and referral for treatment in coordination with social work and psychiatric consultants. We compared pre and post- implementation screening rates among inpatients age 12-18 years and performed sub-group analyses.

RESULTS

There were 873 patients before and 1,091 after implementation. Questionnaire screening increased from 0% to 34.4% (p < 0.001), without an increase in positivity rate, and lab screening decreased by 4.2% (p = 0.003). Females were more likely to receive a social work consultation than males (14.5 vs 7.5%, p < 0.001), despite a greater number of positive questionnaires among males (9.5 vs 17.9%, p = 0.013). White patients were more likely to receive a social work consultation (12.9%) compared to Asian (2%), Black (6.3%), and Other (6.9%) (p = 0.007), despite comparable rates of positive screenings. When comparing English to non-English speakers, English speakers were more likely to have a social work consult (12.0% vs 2.4%, p < 0.001) and psychiatry/psychology consult (13.6 vs 5.6%, p = 0.011).

CONCLUSION

Multidisciplinary training along with an electronic medical record tool increased SBIRT protocol compliance. Demographic disparities in intervention rates may exist.

Using the Electronic Medical Record to Improve Preoperative Identification of Patients at Risk for Obstructive Sleep Apnea

PURPOSE

Obstructive sleep apnea (OSA) is a breathing disorder found in surgical patients and associated with complications in the postoperative period. The implementation of a preoperative universal screening process using the STOP-BANG questionnaire to identify patients at high risk for OSA provides opportunities for improved management.

DESIGN

A pre-post design was used to evaluate screening compliance rates.

METHODS

This initiative included staff education, which included the process for evaluating and documenting STOP-BANG scores. The data were collected via a chart review of the electronic medical record (EMR).

FINDINGS

The rate of screening for OSA doubled after implementation of this initiative, and compliance with STOP-BANG questionnaire screening was 66.1%. High-risk designation in the EMR was 73.0%. Nearly half of the patients screened were found to be at high risk for OSA.

CONCLUSIONS

Implementation of a universal screening initiative for patients and design for the EMR improves compliance with screening and identification of patients at high risk for OSA.