Screening, Brief Intervention, and Referral to Treatment
Vancouver General Hospital
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Each year, unintentional injuries are the number one killer of British Columbians under age 45, and they kill more BC children and youth than all other causes combined. Alcohol is a significant risk factor for injury and identifying patients with substance abuse issues provides a key opportunity for prevention and intervention. Research has shown that screening and brief interventions for individuals whose drinking patterns put them at risk for injury is successful in reducing the amount of alcohol consumed by these individuals and preventing more serious consequences.
Launched in October 2014, the Screening, Brief Intervention, and Referral to Treatment (SBIRT) protocol was developed by the VGH Trauma Services Injury Prevention Program to deliver treatment and early intervention services to patients with substance abuse disorders, or who are at risk for developing them. Click here for more information, including a short video, about the initiative.
SBIRT is an evidence-based, comprehensive, integrated approach that fosters a continuum of care by integrating prevention, intervention, and treatment services, and it improves linkages within and between health care services and alcohol/drug treatment services.
Injured patients are typically first encountered in the Emergency Department (ED), and so the SBIRT was incorporated into the intake process of patients in the ED. A nurse completes the SBIRT screening tool and refers patients who receive a positive score to a social worker for a brief intervention.
The protocol has also been implemented in the Burn Trauma High Acuity Unit, as well as the Orthopaedic and Trauma Units where patients are admitted and followed by the trauma service. A second form was developed to capture patients on the Trauma Unit who may not have been screened for SBIRT in the ED, and to make it easy for nursing to refer a patient to social work for a brief intervention.
Between October 2014 and April 2015, 65% of patients admitted to Trauma Services were screened, nearly half of whom (46%) received a positive score on the SBIRT, identifying them as risky drinkers. Of these patients, 86% were referred to a social worker, 71% of whom received a brief intervention to increase insight and awareness, and motivate behavioural change.
SBIRT is an example of improving the quality of care for patients because not only does it identify people who would otherwise be overlooked because they are not considered alcohol dependent, but it also provides a platform for health care workers to intervene, provide the care needed to reduce alcohol consumption, and increase overall health of patients.
What started out as a process change in Trauma Services, the SBIRT initiative has grown to include activities that reach a wide audience, including a newsletter and an organizational screen saver. VGH Trauma Services recently presented SBIRT at the Trauma Association of Canada Conference where it won best poster and presentation. Since then, the Injury Prevention Program has received inquiries provincially and nationally from trauma centres to help with their implementation of the initiative. The SBIRT protocol is simple and requires little time from clinicians to implement, and VGH Trauma Services hopes that it will be rolled out to hospitals across BC.