An evidence based alcohol screening, brief intervention and referral to treatment (SBIRT) curriculum for emergency department (ED) providers improves skills and utilization

OBJECTIVE

Emergency Departments (EDs) offer an opportunity to improve the care of patients with at-risk and dependent drinking by teaching staff to screen, perform brief intervention and refer to treatment (SBIRT). We describe here the implementation at 14 Academic EDs of a structured SBIRT curriculum to determine if this learning experience improves provider beliefs and practices.

METHODS

ED faculty, residents, nurses, physician extenders, social workers, and Emergency Medical Technicians (EMTs) were surveyed prior to participating in either a two hour interactive workshops with case simulations, or a web-based program (www.ed.bmc.org/sbirt). A pre-post repeated measures design assessed changes in provider beliefs and practices at three and 12 months post-exposure.

RESULTS

Among 402 ED providers, 74% reported < 10 hours of prior professional alcohol-related education and 78% had < 2 hours exposure in the previous year. At 3-month follow-up, scores for self-reported confidence in ability, responsibility to intervene, and actual utilization of SBIRT skills all improved significantly over baseline. Gains decreased somewhat at 12 months, but remained above baseline. Length of time in practice was positively associated with SBIRT utilization, controlling for gender, race and type of profession. Persistent barriers included time limitations and lack of referral resources.

CONCLUSIONS

ED providers respond favorably to SBIRT. Changes in utilization were substantial at three months post-exposure to a standardized curriculum, but less apparent after 12 months. Booster sessions, trained assistants and infrastructure supports may be needed to sustain changes over the longer term.

Tackling multi-pollutant multi-effect problems--an iterative approach

Within both the UN ECE and the European Union, there has been a strong move towards the so-called multi-pollutant multi-effect approach to air pollution strategies. In this approach a number of pollutants are considered, and emission reductions are determined after looking at the effect of each of these pollutants on a number of environmental problems. This new approach is very ambitious and raises a number of problems in balancing the effects and costs of different emission reductions against achieved environmental benefits. We describe an iterative method designed for addressing such multi-pollutant multi-effect type problems. In the examples given here, the method is used to estimate combinations of NOx and VOC emission reductions from all European countries so as to reduce environmental problems associated with acidification and ozone in a cost-effective manner. The iterative technique is designed to be flexible and transparent, so that a number of different approaches to multi-pollutant-multi-effect problems can be considered. This technique can be used to provide early guidance on various control strategy options, and allows rapid exploration of the many targets and measures possible with these approaches. It also demonstrates how even complex multi-dimensional environmental problems may be amenable to understandable solutions.