Development and Implementation of an Emergency Practitioner–Performed Brief Intervention for Hazardous and Harmful Drinkers in the Emergency Department

• Published in: Academic emergency medicine 2005-03, Vol.12 (3), p.249-256
• Main Authors: D'Onofrio, Gail, Pantalon, Michael V., Degutis, Linda C., Fiellin, David A., O'Connor, Patrick G.
• Format: Article
• Language: English
• Subjects: alcohol problems; Alcoholism - therapy; Attitude of Health Personnel; Behavior Therapy - education; Behavior Therapy - methods; brief interventions; Connecticut; Counseling - education; Counseling - methods; Education, Medical, Continuing - methods; Educational Measurement - methods; Emergency Medicine - education; Emergency Medicine - methods; Emergency Service, Hospital - organization & administration; Humans; Motivation; motivational enhancement; Outcome and Process Assessment (Health Care); Pilot Projects; Prospective Studies
• ISSN: 1069-6563; 1553-2712
• DOI: 10.1197/j.aem.2004.10.021

Objectives: 1) To develop and teach a brief intervention (BI) for “hazardous and harmful” (HH) drinkers in the emergency department (ED); 2) to determine whether emergency practitioners (EPs) (faculty, residents, and physician associates) can demonstrate proficiency in the intervention; and 3) to determine whether it is feasible for EPs to perform the BI during routine clinical care. Methods: The Brief Negotiation Interview (BNI) was developed for a population of HH drinkers. EPs working in an urban, teaching hospital were trained during two‐hour skills‐based sessions. They were then tested for adherence to and competence with the BNI protocol using standardized patient scenarios and a checklist of critical components of the BNI. Finally, the EPs performed the BNI as part of routine ED clinical care in the context of a randomized controlled trial to test the efficacy of BI on patient outcomes. Results: The BNI was developed, modified, and finalized in a manual, based on pilot testing. Eleven training sessions with 58 EPs were conducted from March 2002 to August 2003. Ninety‐one percent (53/58) of the trained EPs passed the proficiency examination; 96% passed after remediation. Two EPs left prior to remediation. Subsequently, 247 BNIs were performed by 47 EPs. The mean (± standard deviation) number of BNIs per EP was 5.28 (± 4.91; range 0–28). The mean duration of the BNI was 7.75 minutes (± 3.18; range 4–24). Conclusions: A BNI for HH drinkers can be successfully developed for EPs. EPs can demonstrate proficiency in performing the BNI in routine ED clinical practice.