Expert Panel Nominations

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Standard 0001: Inpatient and emergency department patients are routinely screened at intake or appropriate point by means of standardized verbal or written questionnaire screener to identify patients who require clinical intervention related to their substance use beyond routine education about prevention of relapse.

Performance Requirements for 0001

• 0001 - Percent of inpatients annually screened for risk of problems due to drinking or substance use (including non-medical use of prescription medications).

Numerator: Eligible adult inpatients with medical record documentation of screening for alcohol use with AUDIT-C or full AUDIT and the NIDA one question drug use screener.

Denominator: Adult patients admitted to the hospital.

Scoring: numerator divided by the denominator multiplied by 100 to convert to a percent.

• 0002 - Percent of inpatients admitted for trauma or for hepatitis annually screened for risk of problems due to drinking or substance use (including non-medical use of prescription medications).

Numerator: Eligible adult inpatients admitted for trauma or hepititis with medical record documentation of screening for alcohol use with AUDIT-C or full AUDIT and the NIDA one question drug use screener.

Denominator: Adult patients admitted for trauma or hepititis to the hospital.

Scoring: numerator divided by the denominator multiplied by 100 to convert to a percent.

• 0003 - Percent of emergency department annually screened for risk of problems due to drinking or substance use (including non-medical use of prescription medications).

Numerator: Eligible adult emergency department patients with medical record documentation of screening for alcohol use with AUDIT-C or full AUDIT and the NIDA one question drug use screener.

Denominator: Adult emergency department patients.

Scoring: numerator divided by the denominator multiplied by 100 to convert to a percent.

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Standard 0002: Inpatient and emergency department patients who screen positive for unhealthy alcohol or drug use receive brief motivational enhancement-oriented counseling to encourage reduced hazardous use of alcohol and other drugs and prevent future complications or dependence.

Performance Requirements for 0002

• 0001 - Percent of adult ipatients who receive a brief intervention for unhealthy or dependent alcohol use or substance use (including non-medical use of prescription medications).

Numerator: Eligible inpatients with medical record documentation of brief counseling for unhealthy alcohol and/or drug use.

Denominator: Adult inpatients.

Scoring: numerator divided by the denominator, multiplied by 100 to convert ot a percent.

Rationale: Brief intervention is a separate procedure from screening. Although the proportion of adults patients who receive a brief intervention depends on the prevalence of unhealthy and dependent alcohol and drug use (including prescription medication misuse) in the base population, medical records documentation of brief interventions for substance use problems ought not be rare phenomena (~7.5% in general, non-psychiatric inpatients, according to an NIAAA epidemiologic survey)

• 0002 - Percent of adult inpatients admitted for trauma or hepititis who receive a brief intervention for unhealthy or dependent alcohol use or substance use (including non-medical use of prescription medications).

Numerator: Eligible inpatients admitted for trauma or hepititis with medical record documentation of brief counseling for unhealthy alcohol and/or drug use.

Denominator: Adult inpatients admitted for trauma or hepititis.

Scoring: numerator divided by the denominator, multiplied by 100 to convert ot a percent.

Rationale: Brief intervention is a separate procedure from screening. Although the proportion of adult inpatients admitted for trauma or hepititis who receive a brief intervention depends on the prevalence of unhealthy and dependent alcohol and drug use (including prescription medication misuse) in the base population, medical records documentation of brief interventions for substance use problems ought not be rare phenomena (CDC estimates between 40% and 60% of trauma admissions are caused or complicated by substance use)

• 0003 - Percent of adult emergency department patients who receive a brief intervention for unhealthy or dependent alcohol use or substance use (including non-medical use of prescription medications).

Numerator: Eligible adult emergency department patients with medical record documentation of brief counseling for unhealthy alcohol and/or drug use.

Denominator: Adult emergency department patients.

Scoring: numerator divided by the denominator, multiplied by 100 to convert to a percent.

Rationale: Brief intervention is a separate procedure from screening. Although the proportion of adult emergency department patients who receive a brief intervention depends on the prevalence of unhealthy and dependent alcohol and drug use (including prescription medication misuse) in the base population, medical records documentation of brief interventions for substance use problems ought not be rare phenomena (CDC estimates between 10% and 20% of emergency department adult visits are caused or complicated by substance use)

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Standard 0003: For patients who are medically unstable (e.g., acute trauma, myocardial infarction, and stroke) or psychiatrically unstable (e.g., delirium and imminent risk of harm to self and/or others) or acutely intoxicated, the program makes appropriate referrals for urgent and specialty substance use care or secures substance use consultation to manage the acute episode, and to provide continued care management.

Performance Requirements for 0003

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Note: Use the section above to draft a new Standard (or click on the buttons next to an existing draft standard to modify it). When creating or modifying a draft Standard, you may add or modify Performance Requirements associated with that Standard. A Standard represents the basic concept and a Performance Requirement describes the means to assess compliance with the standard.

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Comments

08 Jul 08 13:51 | EricGoplerud said...:
Several emergency physicians have commented that the hospital emergency departments are horribly overburdened, and that as laudable as the goal of alcohol and drug screening is, that there is just too much going on and too many demands on their time to be asked to do even one more thing. A recent report found that wait times in EDs is increasing, and that patients with heart attacks often must wait 20 minute or more before initiating treatment. Hospital emergency department or trauma center SBI should not be seen as yet another burden put on the physician. Rather it is a function that the hospital as an organization should be addressing, perhaps through a hospital social worker, nurse, health educator, or even, as is being done in some facilities, by bedside computer or by a peer counselor (a trained person in recovery). Paper and pencil or computer administered standardized screening questionnaires such as the AUDIT, the DAST or ASSIST, or the very brief one-question heavy alcohol use pre-screener recommended by NIAAA, a single question pre-screener of prescription medication misuse being tested by NIDA, or blood or urine tests can be administered with very minimal time or resource commitment. Brief counseling or brief referral for specialty treatment should be a facility responsibility of the ED, Trauma Center or inpatient service, not an added burden to the physician.

28 Apr 08 08:10 | MartinDoot said...:
The simple screening tools have been in the literature my whole career. The prevalence of the alcohol and drug disorders in the acute care setting have been verified over and over again. We have researched implementing SBIRT in large instituitons (if Cook County hospital can implement it anyone should be able to) and yet too few patients are still adequately screened, assessed, intervened on and/or referred for treatment services. My latest research in this area simply held a group of residents in primary care accountable by auditing 1 chart per week by the faculty and giving feedback on the use of the CAGE and a quantity/frequency question. That accountability increased the screening rate by 70%. By making SBI a Joint Commission Standard we could accomplish the same results by holding acute care hospitals accountable for this well researched intervention. It would be about time!

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