High Proportion of Patients Screened when Alcohol and Drug Questions are Integrated into Emergency Department Electronic Triage Forms

Although the prevalence is high, unhealthy alcohol and other drug use often goes unrecognized in emergency department (ED) patients. To screen a higher proportion of patients, investigators implemented three questions concerning past 12-month substance use in the electronic triage form of a level I trauma hospital ED, to be administered by nurses to every patient aged 18 or over: a multiple choice question on the number of heavy drinking days, and two yes/no questions for tobacco or other drug use. Any drug or heavy alcohol use triggered a brief intervention by a health education specialist.

• Over three years, 145,394 adults (96%) had screening documented. About 200 persons screened positive each week for either drug or at-risk alcohol use, accounting for 20–26% of patients.
• After an initial proportion of 89% screened, the proportion increased over the next 18 months to reach a plateau, remaining at over 96% for the remaining year and a half.
• About 40% of those who screened positive did not receive a brief intervention, because the health education specialists were not always available.

Comments:

The proportion of patients screened after implementing systematic screening for substance use in ED electronic triage forms was high. Further information would have been useful regarding the small proportion of patients not screened, who were likely critically ill or otherwise unable to participate in screening. More importantly, the study does not indicate whether the validated screening questions were actually asked. It also points to a clear challenge—that of acting on positive screening results (i.e., with a brief intervention or treatment referral, where indicated).

Christine Maynié-François, MD, MSc † & Richard Saitz, MD, MPH

Reference:

Johnson JA, Woychek A, Vaughan D, Seale JP. Screening for at-risk alcohol use and drug use in an emergency department: integration of screening questions into electronic triage forms achieves high screening rates. Ann Emerg Med. 2013;62(3):262–266.