20 May 08 16:25 | CarlosAbel said regarding ScreeningAndBriefIntervention:
Oportunity
I am screening patients during three months; all of this is new for me, I found that it is a great opportunity to offer to patients, in the right time.

Visiting the ED, give the patient the opportunity to thing about the future of the lack of it.

The hard part in prevention programs is to demonstrate how many lives we are saving. In general the numbers give us a great idea where we are and where we want to go. We know, somehow, when we are making an impact in some ones live, asking the right questions, and helping patients to find their inner power to improve his live and commit to do something about his addictions.

I am encouraging every one at the medical staff to follow and adopt SBIRT in their practice. It is making a difference and the consistency on this will keep doing a difference in everybody’s life, because the addiction dieses affect all of us directly or indirectly.

13 May 08 12:29 | KevinCarlin said regarding ScreeningAndBriefIntervention:
I agree with what has been written. This standard will help push the integration of preventative care, such as SBIRT services, with primary and emergency care and increase the health of each community in the nation by reducing the numerous substance-related problems that fill our EDs right now.

01 May 08 16:43 | MichaelBotticelli said regarding ScreeningAndBriefIntervention:
The Massachusetts Department of Public Health Bureau of Substance Abuse Services fully supports development of national JCAHO standards for SBI. In 2005 the Bureau brought together a group of experts to help us develop a long term Strategic Plan. Expert and consumer input cited decades of research showing that early signs of risky or problem use could be caught early and addressed before full blown problems developed. One of the key priorities in our Strategic Plan is expansion of screening, assessment and referral of those at risk for or needing treatment for alcohol and drug problems in community, agency and health care settings. In late 2006 Massachusetts was awarded multi-million dollar SAMHSA funding to develop an SBIRT model in health care settings that can be broadly replicated across the state. In the meantime, we also started to fund a capacity building project in 12 Emergency Departments around the state and in 32 Community Health Centers. A standard requirement to screen, and intervene when risk is found, would reinforce these efforts and help us sustain them in Massachusetts

01 May 08 09:09 | ScottWilliams said regarding ScreeningAndBriefIntervention:
Comment re-posted for EdwinBoudreaux
I agree with the comments posted. I would also like to emphasize three points: (1) one model for SBIRT does not fit all, (2) empirically supported strategies should be advocated, and (3) we continue to need more evidence to support different SBIRT models for illicit drug abuse. We should encourage research and development of a variety of models, ranging from healthcare provider-based counseling to interventionist-driven models to technologically-driven models (e.g., computerized screening, tailored motivational reports, and electronic referrals). While SBIRT is clearly important and much research is available to support its use, especially with alcohol, we continue to need rigorous clinical trials, economic analyses, and dissemination trials for new SBIRT models, especially those that blend approaches, such as healthcare provider-based counseling combined with technologically-driven interventions. Finally, I believe the biggest barrier to implementation is financial viability. Most of the economic analyses that are published examine cost-benefit analyses, relying primarily upon cost aversion to argue for viability. However, hospital administrators typically do not value such evidence, and, rather, look to the bottom line. Studies are needed to prove that the reimbursement derived from applying SBIRT covers the cost of the personnel time and other expenses.

30 Apr 08 17:26 | JudithBernstein said regarding ScreeningAndBriefIntervention:
I am a nurse and a public health researcher. From this dual vantage point, I know that clinicians want to practice effective, high quality care, but time pressures and lack of reimbursement and structural supports are real barriers. Regulatory measures help people do the right thing. A new Joint Commission accreditation standard is just the ammunition we need to speed dissemination of this evidence-based procedure and improve patient outcomes.

30 Apr 08 10:32 | JudyAltizer said regarding ScreeningAndBriefIntervention:
As a charge nurse in a rural, college town ED, I know first hand how often our patients are effected by alcohol-related injuries, acute alcohol intoxication, sexual assault related to alcohol, or face chronic alcohol use disorders. As a graduate student I have been researching the SBIRT topic and watched with excitement as ENA ED SBIRT has evolved. I strongly believe this program should be implemented in every ED setting as alcohol misuse has negative consequences for the health and safety of patients and the community in all settings around the USA. With the education and motivation provided through the ENA, ED staff nurses can and must incorporate ED SBIRT into standard of care to improve outcomes and reduce recidivism. Hospital administrations should be encouraged to support the education and facilitation of ED SBIRT as administration has often been described in the literature as a barrier.

29 Apr 08 14:06 | SusanBarnard said regarding ScreeningAndBriefIntervention:
It would be fantastic to have SBIRT implemented in all ED's! It is an evidence-based approach that when properly done does not take a lot of time as compared with the repeat care of repeat trauma patients. WE often have similar discussions with our patients anyway as we simultaneoulsy give care - this is a way to standardize those discussions and provide proper direction. Resourses may be an issue initially, but the long term effects should decrease the ED work load, not increase it.

29 Apr 08 09:03 | RickMoore said regarding ScreeningAndBriefIntervention:
As a Trauma Program Coordinator with 14 years experience I know first hand the issues caused by alcohol use, especially drinking and driving. I currently work in a city with a major 4 year university and a major 2 year college. Party hearty weekends are the norm. Our ED staff would have frequent opportunity to utilize SBIRT. This should be the standard for all hospital ED's across the nation. These brief interventions, when utilized correctly can make a difference in a young adults life. There are those who will say we don't have the time or the money to institute this in our facilities. Truthfully there may be some small monetary outlay for the initial training. As far as time, the "B" stands for "brief" just a couple of minutes to interact with the patient, while starting an IV or performing the nursing assessment. That is all it takes, just insert this in place of normal conversation or awkward silence. And, if the studies are correct, we may curtail the risky behaviors that people engage in that has our ED's so over crowded in the first place.

28 Apr 08 12:21 | SusanCohee said regarding ScreeningAndBriefIntervention:
We are in the process of implementing SBIRT. At this point we will screen all patients according to the SBIRT model. Having worked in the ED for 25 plus years it is so apparent this is a fairly simple way to " put the ball" back in the clients court and allow them to make changes. I think that JCAHO should establish an accreditation standard which would make it necessary for hospitals and other appropriate health provider institutions to use this.

28 Apr 08 11:39 | MichaelLevine said regarding ScreeningAndBriefIntervention:
Reality Check
Harsh Realities...time and money. Everyone is gung ho about this SBIRT thing and I agree that the concept is a positive one. Having been involved with a pilot program in my hospital, I can tell you that if you think that your staff will be willing to do this screening with all of the spare time that is afforded them during their mundane work day, you may be a little disappointed. Very few facilities have the time and resources to make this a reality. Colorado seems to have reeceived a multi-million dollar grant to implement this screening which actually pays for a real live human being to do the screening in various facilities. It is not that doctors and nurses don't care, it is a matter of time available for the task.

Private institutions will bear grave financial burdens if this becomes a JCAHO requirement. Should the government suddenly realize the importance of this screening and cancel the manufacture of one or two large munitions, we could receive money in every hospital in America to launch and maintain an SBIRT program. Otherwise, the program has the potential to gravely disrupt the financial function of a medical institution.

As an aside, I am a staff RN in an ED without any personal responsibility for finance.