Implementation of Screening, Brief Interventions, and Referral to Treatment (SBIRT) in the Emergency Department

Introduction: Drug and alcohol use is an epidemic health problem affecting Americans at an unprecedented scale. The Screening, Brief Intervention, and Referral to Treatment (SBIRT) initiative was introduced in 2003 by the Substance Abuse and Mental Health Services Administration (SAMHSA) as a framework to leverage any interaction time between patients and healthcare providers to screen for drug and alcohol use, provide brief interventions, and appropriately refer individuals to substance rehabilitation treatment. The program was intended for use in different healthcare facilities, including emergency departments. Purpose & Design: This project was an implementation of evidence into practice to implement the Screening, Brief Intervention, and Referral to Treatment (SBIRT) framework in the Emergency Department (ED) of a California Hospital as a standard nursing intervention for all patients (18 - 65 years of age). This study aimed to evaluate the implementation and impact of SBIRT as a routine nursing practice within an ED. Method: The ED nursing staff (N = 125) received 4-hour SBIRT training, and the components of SBIRT were incorporated into the nursing process. Major outcomes were nursing staff knowledge of SBIRT and performance of implementing SBIRT interventions. Nursing staff knowledge was measured using the validated Confidence Scale (C-scale) pre-training, immediately post-training, and six-week post training. The C-Scale is a five-point Likert scale developed by Grundy (1993) to measure confidence in clinical skills. For this project, we used it to assess how confident staff felt in carrying out SBIRT interventions. Performance was measured by the percentage of eligible patients who received interventions in the first 6 weeks. Results: A paired sample t-test revealed a statistically significant difference between the total scores of the C-scale pre-test (M = 7.82, SD = 4.13) and immediate post-test (M = 16.81, SD = 3.7), t(86) = 17.6, p < 0.001) and a statistically significant difference across all five items of the C-scale. In the first six weeks, 3.5% of eligible patients visiting the ED received an SBIRT intervention. Conclusion: Training the ED nursing staff and incorporating SBIRT interventions into the ED workflow was feasible, acceptable, and potentially effective. SBIRT implementation in the ED improves nursing knowledge, but intervention rates were lower than expected due to workflow barriers.