Alcohol and Other Drug Screening of Hospitalized Trauma Patients
Treatment Improvement Protocol (TIP) Series: 16
TIP 16: Alcohol and Other Drug Screening of Hospitalized Trauma Patients
Alcohol and Other Drug Screening of Hospitalized Trauma Patients
[Front Matter]
[Title Page]
Alcohol and Other Drug Screening of Hospitalized Trauma Patients Treatment Improvement Protocol (TIP) Series 16
Peter O. Rostenberg, M.D. Consensus Panel Chair
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Rockwall II, 5600 Fishers Lane Rockville, MD 20857 DHHS Publication No. (SMA) 95-3039. Printed 1995.
This publication is part of the Substance Abuse Prevention and Treatment Block Grant technical assistance program. All material appearing in this volume except quoted passages from copyrighted sources is in the public domain and may be reproduced or copied without permission from the Center for Substance Abuse Treatment (CSAT) or the authors. Citation of the source is appreciated.
This publication was written under contract number ADM 270-91-0007 from the Center for Substance Abuse Treatment of the Substance Abuse and Mental Health Services Administration (SAMHSA). Sandra Clunies, M.S., served as the CSAT Government project officer, and Roberta Messalle was the Government content advisor. Text development was provided by Carl Leukefeld, D.S.W. Writers were Carolyn Davis, Joni Eisenberg, Constance Gartner, Randi Henderson, and Deborah Shuman.
The opinions expressed herein are the views of the consensus panel members and do not reflect the official position of CSAT or any other part of the U.S. Department of Health and Human Services (DHHS). No official support or endorsement of CSAT or DHHS for these opinions or for particular instruments or software that may be described in this document is intended or should be inferred. The guidelines proffered in this document should not be considered as substitutes for individualized patient care and treatment decisions.
CSAT Treatment Improvement Protocols (TIPs) are prepared by the Quality Assurance and Evaluation Branch to facilitate the transfer of state-of-the-art protocols and guidelines for the treatment of alcohol and other drug (AOD) abuse from acknowledged clinical, research, and administrative experts to the Nation's AOD abuse treatment resources.
The dissemination of a TIP is the last step in a process that begins with the recommendation of an AOD abuse problem area for consideration by a panel of experts. These include clinicians, researchers, and program managers, as well as professionals in such related fields as social services or criminal justice.
Once a topic has been selected, CSAT creates a Federal resource panel, with members from pertinent Federal agencies and national organizations, to review the state of the art in treatment and program management in the area selected. Recommendations from this Federal panel are then transmitted to the members of a second group, which consists of non-Federal experts who are intimately familiar with the topic. This group, known as a non-Federal consensus panel, meets in Washington for 5 days, makes recommendations, defines protocols, and arrives at agreement on protocols. Its members represent AOD abuse treatment programs, hospitals, community health centers, counseling programs, criminal justice and child welfare agencies, and private practitioners. A Chair for the panel is charged with responsibility of ensuring that the resulting protocol reflects true group consensus.
The next step is a review of the proposed guidelines and protocol by a third group whose members serve as expert field reviewers. Once their recommendations and responses have been reviewed, the Chair approves the document for publication. The result is a TIP reflecting the actual state of the art of AOD abuse treatment in public and private programs recognized for their provision of high quality and innovative AOD abuse treatment.
This TIP Alcohol and Other Drug Screening of Hospitalized Trauma Patients examines the extensive role that alcohol and other drug abuse plays in traumatic injury. The costs of injury to both individuals and society are high. In financial terms, the annual direct and indirect costs of providing care for injured persons are higher than the costs of care for persons with cancer or heart disease. Persons who sustain one injury are at greatly increased risk of reinjuring themselves and others. Untreated substance use disorders are thought to be the cause of a large portion of reinjury. For these and other reasons, the consensus panel recommends universal alcohol and drug screening of injured patients ages 14 and older upon hospital admission.
The TIP provides guidelines for addressing positive results of screens. The purpose of screening is twofold: to improve the medical management of these patients during hospitalization and injury rehabilitation and to help identify a subgroup of patients with untreated AOD problems who can be referred to treatment, if appropriate. The TIP is targeted both to professionals in the treatment field, who may not be familiar with traumatic injuries, and to medical professionals, who may be considering implementing screening programs in their facilities. It is hoped that the TIP will help bring closer together two groups of care providers to improve care and more effectively address injury prevention.
This TIP represents another step by CSAT toward its goal of bringing national leadership to bear in the effort to improve AOD abuse treatment.
Other TIPs may be ordered by contacting The National Clearinghouse for Alcohol and Drug Information (NCADI), (800) 729-6686 or (301) 468-2600; TDD (for hearing impaired), (800) 487-4889.
The Treatment Improvement Protocol Series (TIPs) fulfills CSAT's mission to improve alcohol and other drug (AOD) abuse and dependency treatment by providing best practices guidance to clinicians, program administrators, and payers. This guidance, in the form of a protocol, results from a careful consideration of all relevant clinical and health services research findings, demonstration experience, and implementation requirements. A panel of non-Federal clinical researchers, clinicians, program administrators, and patient advocates employs a consensus process to produce the product. This panel's work is reviewed and critiqued by field reviewers as it evolves.
The talent, dedication, and hard work that TIPs panelists and reviewers bring to this highly participatory process have bridged the gap between the promise of research and the needs of practicing clinicians and administrators. We are grateful to all who have joined with us to contribute to advance our substance abuse treatment field.
Nelba Chavez, Ph.D.
Administrator
Substance Abuse and Mental Health Services Administration
This Treatment Improvement Protocol (TIP) has been written for a wide-ranging audience, including State alcohol and other drug (AOD) authorities; administrators and staff of AOD abuse treatment programs; emergency department and hospital personnel, such as physicians, nurses, and social workers; public health authorities; and healthcare policymakers. Some readers may find that certain chapters contain material with which they are highly familiar. The chapters are described below so that readers can select those of primary interest.
Chapter 1 Introduction describes the significant role that substance use, abuse, and dependence play in traumatic injury and reinjury and presents statistics and other evidence of the broad scope of the problem. While this chapter will be informative to all audiences, it is particularly targeted to policymakers to bring attention to the social and financial costs of this problem.
Chapter 2 Trauma Patients describes hospitalized trauma patients, including the types of injuries they sustain and their treatment and rehabilitation. Physicians, nurses, and other hospital personnel will be highly familiar with the material presented. The chapter is primarily targeted to AOD abuse treatment providers.
Chapter 3 Effects of Alcohol and Other Drugs on Trauma Patients describes the effects of acute and chronic AOD use on the management of trauma patients, both in the emergency phase of treatment and later in the subacute and rehabilitation phases. Insofar as the chapter provides strong evidence for the value of ascertaining patients' AOD status via screening and assessment and making AOD interventions when appropriate, the chapter will be informative to all audiences.
Chapter 4 Screening and Assessment describes the processes of screening and assessment for AOD use, abuse, and dependence. Several widely used screening questionnaires are described. The chapter is targeted primarily to hospital personnel and administrators who may be considering establishing a screening program. Most AOD treatment providers will be very familiar with these processes. However, the chapter also reviews research and current thinking on the effectiveness of brief AOD interventions and presents guidelines for making such interventions in the hospital setting. This information will be of interest to all care providers.
Chapter 5 Cost-Benefit Issues Affecting Implementation of Screening discusses the benefits of screening of hospitalized trauma patients and the financial costs associated with implementing a screening program. The chapter will be of most interest to hospital administrators and policymakers.
Chapter 6 Legal and Ethical Concerns explores ethical issues concerning protection of patients' confidentiality and the use of screening. A case example illustrates these concerns. The chapter is targeted primarily to care providers in the hospital setting.
Chapter 7 Recordkeeping and Quality Improvement addresses the issue of handling records to protect patients' confidentiality. The chapter explores ways in which outcomes can be defined and measured in order to ensure the continued quality improvement of the screening and assessment program. The chapter is targeted primarily to care providers in the hospital setting.
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