Screening for Our Safety SOS: Alcohol Screening in the Emergency Department

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Screening for Our Safety (SOS) Alcohol
Screening in the Emergency Department
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AAA Foundation for Traffic Safety

• Established in 1947
• 501 (c)(3) Not-For-Profit
• Research affiliate of AAA/CAA
• North American Focus

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Mission

• Identify traffic safety problems
• Foster research that seeks solutions
• Disseminate information and educational materials

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Funded through the generosity of and its
members
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Published September 2006 Prepared by Michael J.
Mello, MD, MPH Injury Prevention Center at Rhode
Island Hospital Brown Medical School Available
online at www.aaafoundation.org In partnership
with Brown Medical School and Rhode Island
Hospital
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Making the ED Part of the Solution to Impaired
Driving

• Screening and brief interventions in the ED
• Literature review
• Other research at our institution
• RIES project
• DIAL project
• REDUCE project

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Making the ED Part of the Solution to Impaired
Driving

• Physician reporting of impaired drivers
• Law enforcement
• Department of Motor Vehicles Medical Review
  Board
• -Voluntary
• -Mandatory
• Earlier research of ours showed that
  physicians were more comfortable reporting
  impaired drivers using a DMV medical model than
  to law enforcement

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SOS project an online educational program
Phase 1 An online curriculum for emergency
physicians was developed on alcohol-related
injuries, screening for alcohol use, brief
interventions, referral for treatment, and
reporting of impaired drivers Phase 2 The
curriculum was tested and evaluated with RI
emergency physicians

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SOS Overview

• Internet based program
• Brief, but allows user to access more information
  when interested
• Contained latest literature on topics of SBI,
  alcohol and injury, local data, laws, resources

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Learning objectives for the curriculum

• Increase knowledge about
• The usefulness of screening for alcohol use
  problems with ED patients
• Options available for patients who screen
  positive for alcohol use problems
• The significance of alcohol use and injury, the
  prevalence of impaired driving in Rhode Island,
  and mechanisms available for reporting impaired
  drivers

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Evaluation of SOS Program

• Recruitment email sent to all emergency medicine
• physicians in RI (n 127)
• Pre-test and post test done with curriculum
• Follow-up surveys done at 3 month and 6 month
• Medical chart review at select hospitals
• Tracking number of DMV reports

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Participating physicians

• 75 physicians participated in program
• (20 gift card given for participating)
• Type of ED for those responding
• 61 practiced at a teaching hospitals ED
• 28 at a community hospital ED
• 11 at both
• Experience of those responding
• 38 graduated from medical school in 2000 or later

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Participants evaluation of program

• Overall clinical usefulness of the SOS curriculum
  
• 96 indicated that it was useful
• Objective of educational on the role of alcohol
  with injury and usefulness of ED brief
  interventions
• 98 indicated that it met these objective
• Curriculum met the objective of educating
  emergency physicians on alcohol screening tools
• 100 felt met this objective
• Objective of educating physicians on referrals
• 87 indicated that it had met this objective
• Length of the curriculum was appropriate
• 98 agreed

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Physicians Self-reported Clinical Practice

• Post-test after finishing curriculum
• 87 indicated they would increase their alcohol
  screening of injured ED patients
• Discussed alcohol use with patients with
  suspected alcohol related injuries 45 of the
  time on average at 3 month follow-up 58 of the
  time on average at 6 month follow-up

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Objective measure of clinical practice
Medical Record review of ED charts for MVC
patients treated at state trauma center and one
community hospital for one month pre and post
SOS

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Objective measure of clinical practice

Number of physicians reports for alcohol
impairment to Rhode Island DMV Medical Review
Board
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ED Physicians Advocacy
In the 6 month follow-up survey, 37 of
respondents offered to take part in statewide
advocacy efforts related to impaired driving and
provided personal contact information.

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Summary

• Enlisted almost 60 of physicians in the state to
  take internet based program
• Found self reported change in clinical practice
• Demonstrated some objective changes in clinical
  practice
• Created a network of physician willing to
  advocate on this issue

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Limitations

• Single small state
• Mostly younger academic oriented physicians
• Objective data not specific to participants
• DMV reporting laws in RI
• Follow-up rates for project

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Potential Future Directions

• Address limitations of of using our single state
• First replicate in larger state with similar DMV
  reporting model
• Next replicate in states with differing models

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• For more information,
• please go to
• www.aaafoundation.org

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The AAA Foundation for Traffic Safety is a
501(c)(3) public charity located in Washington,
DC that is dedicated to saving lives and reducing
injuries. It is supported by donations from
AAA/CAA Clubs, AAA/CAA members, and other
organizations associated with AAA/CAA.