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Troncoso-Munoz S, Davis KD. Integration of Substance Use Screening Into the Electronic Health Record for Adolescent Trauma Patients: A Quality Improvement Project. J Trauma Nurs 2024; 31:109-114. [PMID: 38484167 DOI: 10.1097/jtn.0000000000000780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
BACKGROUND Adolescent substance abuse is a well-acknowledged and increasing concern. Screening brief intervention and referral to treatment for alcohol and drug use in adolescent trauma is a requirement, but program implementation remains a challenge for many trauma centers. OBJECTIVE This study aims to examine the effect of an integrated electronic health record screening tool and staff training on screening, brief intervention, and referral to treatment compliance in adolescent trauma. METHODS This is a single-center, pre- and postintervention study of substance use screening compliance in adolescent trauma patients (age 12-21) conducted at a Level I pediatric trauma center in the Southeastern United States following the integration of the CRAFFT substance abuse screening tool into the electronic health record. The study compared 12 months of preintervention data (January 2021 through January 2022) to 15 months of postintervention data (February 2022 through May 2023). RESULTS A total of N = 241 patients met inclusion criteria, of which most were male, n = 168 (69.7%), White n = 185 (76.8%), and Hispanic n = 179 (74.3%). Screening compliance increased from preintervention 81% to postintervention 92%. CONCLUSION Our study demonstrates that integrating a digital screening tool into the electronic health record resulted in an average increased screening compliance of 11%.
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Affiliation(s)
| | - Khalil D Davis
- Author Affiliations: Department of Trauma, Nicklaus Children's Hospital, Miami, FL (Mrs Troncoso-Munoz and Mr Davis)
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Helfrich AM, Fraser JA, Hickey PW. Destination based errors in chloroquine malaria chemoprophylaxis vary based on provider specialty and credentials. Travel Med Infect Dis 2022; 47:102310. [DOI: 10.1016/j.tmaid.2022.102310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 03/05/2022] [Accepted: 03/08/2022] [Indexed: 11/28/2022]
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Kam S, Angaramo S, Antoun J, Bhatta MR, Bonds PD, Cadar AG, Chukwuma VU, Donegan PJ, Feldman Z, Grusky AZ, Gupta VK, Hatcher JB, Lee J, Morales NG, Vrana EN, Wessinger BC, Zhang MZ, Fowler MJ, Hendrickson CD. Improving annual albuminuria testing for individuals with diabetes. BMJ Open Qual 2022; 11:bmjoq-2021-001591. [PMID: 35101868 PMCID: PMC8804706 DOI: 10.1136/bmjoq-2021-001591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 01/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background Annual albuminuria screening detects the early stages of nephropathy in individuals with diabetes. Because early detection of albuminuria allows for interventions that lower the risk of developing chronic kidney disease, guidelines recommend annual testing for all individuals with type 2 diabetes mellitus and for those with type 1 diabetes for at least 5 years. However, at the Eskind Diabetes Clinic at the Vanderbilt University Medical Center, testing occurred less frequently than desired. Methods A quality improvement team first analysed the clinic’s processes, identifying the lack of a systematic approach to testing as the likely cause for the low rate. The team then implemented two successive interventions in a pilot of patients seen by nurse practitioners in the clinic. In the first intervention, staff used a dashboard within the electronic health record while triaging each patient, pending an albuminuria order if testing had not been done within the past year. In the second intervention, clinic leadership sent daily reminders to the triage staff. A statistical process control chart tracked monthly testing rates. Results After 6 months, annual albuminuria testing increased from a baseline of 69% to 82%, with multiple special-cause signals in the control chart. Conclusions This project demonstrates that a series of simple interventions can significantly impact annual albuminuria testing. This project’s success likely hinged on using an existing workflow to systematically determine if a patient was due for testing and prompting the provider to sign a pended order for an albuminuria test. Other diabetes/endocrinology and primary care clinics can likely implement a similar process and so improve testing rates in other settings. When coupled with appropriate interventions to reduce the development of chronic kidney disease, such interventions would improve patient outcomes, in addition to better adhering to an established quality metric.
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Affiliation(s)
- Sharon Kam
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | | | - Manasa R Bhatta
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - Adrian G Cadar
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | | | - Zachary Feldman
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Alan Z Grusky
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Veerain K Gupta
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Jeremy B Hatcher
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Jaclyn Lee
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - Erin N Vrana
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - Michael Z Zhang
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Michael J Fowler
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Department of Medicine, Division of Diabetes, Endocrinology, and Metabolism, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Chase D Hendrickson
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Department of Medicine, Division of Diabetes, Endocrinology, and Metabolism, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Roubil JG, Hazeltine MD, Bludevich BM, Aidlen JT, Pustis N, Ferrante C, Hirsh MP, Cleary MA. Assessing screening, brief intervention, and referral to treatment (SBIRT) compliance and disparities for pediatric inpatients at a tertiary care facility. J Pediatr Surg 2022; 57:111-116. [PMID: 34740443 DOI: 10.1016/j.jpedsurg.2021.09.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 01/09/2023]
Abstract
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.
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Affiliation(s)
- John G Roubil
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Max D Hazeltine
- Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - Bryce M Bludevich
- Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jeremy T Aidlen
- Department of Surgery, Division of Pediatric Surgery, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA 01655, USA
| | | | | | - Michael P Hirsh
- Department of Surgery, Division of Pediatric Surgery, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA 01655, USA
| | - Muriel A Cleary
- Department of Surgery, Division of Pediatric Surgery, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA 01655, USA.
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