Alcohol has been shown to be a significant risk factor for injury. Emergency departments (EDs), where injured patients are treated daily, are a particularly appropriate setting for screening for alcohol use problems. However, physicians do not universally address alcohol’s role in injuries; reasons include the busy clinical environment of EDs, variable and changing state laws, physicians’ imprecise estimation of the scope of the problem, and patchy dissemination of information about measures for addressing alcohol issues. This report provides background information on alcohol-related injury, screening, and interventions, describes the Screening for Our Safety (SOS) project, and discusses the potential utility of SOS as a mechanism by which interested organizations could partner with emergency physicians to reduce impaired driving in their communities. The objectives of the SOS project were to create an online educational program for emergency physicians on alcohol use disorders and injury, to increase awareness of the need to screen ED patients for alcohol use disorders, and to present potential interventions for patients who screen positive. Alcohol screening methods presented in the curriculum included quantity/frequency assessment, standardized instruments to assess risky alcohol use, and/or blood alcohol testing.The project involved two phases. In phase 1, an interactive 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. In phase 2, the curriculum was tested and evaluated with emergency physicians in Rhode Island. Of the 127 eligible emergency physicians in the state, 59% responded positively to the SOS recruitment materials and participated; of these, 71% were male, and 38% had graduated from medical school in 2000 or later. When asked about the overall clinical usefulness of the SOS curriculum, 96% of respondents indicated that it was useful, and 98% felt the length of the curriculum was appropriate. Participation increased the group’s knowledge about the role of alcohol in fatal motor vehicle crashes; a significant increase was observed from pretest to posttest surveys in the correct estimation of the proportion of fatal motor vehicle crashes in Rhode Island that are alcohol related, and this knowledge was maintained at follow-up 3 months later. Before taking the curriculum, only 65% of participants knew that Rhode Island physicians are permitted to report alcohol-impaired drivers to the Division of Motor Vehicles (DMV); after completing the curriculum, 100% of participants responded correctly to a question testing this knowledge. Although in the pretest survey, 59% of participants indicated that they would be unlikely to raise the issue of alcohol with an injured patient, at the 3-month follow-up, 45% of participants indicated that in the previous 30 days they had discussed with their patients the role that alcohol may have had in their injury; at the 6-month follow-up, 58% of respondents had done so. After completing the curriculum, 91% reported that they planned to increase their reporting of impaired drivers to the DMV. Objective measures indicated that during a 3-month period preceding delivery of the SOS curriculum, 17 physician reports of impaired driving were sent to the DMV, and in a 3-month period after delivery of the curriculum, 42 reports were sent. A review of ED medical records at two of the participating hospitals showed that before the curriculum, only 14% of patients with positive alcohol screens were referred for intervention, whereas after the curriculum, 32% were referred. In summary, the SOS project created an online educational curriculum that was accessed by a majority of emergency physicians statewide. After completing the curriculum, participants reported that they would screen patients for alcohol use problems more often, and at follow-up they reported that they were screening injured patients more frequently. These self-reported changes were supported by findings from a review of medical records at two hospitals as well as by the number of reports of impaired drivers submitted to the Rhode Island DMV. At the conclusion of the project, in the 6-month follow-up survey, 37% of responding physicians indicated an interest in taking part in statewide advocacy efforts in this area and provided their personal contact information. These physicians will form a useful advocacy partner to address impaired driving issues in our state. The SOS program has potential for educating emergency physicians in other states on alcohol and injury, impaired driving, and screening for alcohol use problems as well as for creating partnerships for advocacy efforts to reduce impaired driving. (Author/publisher)
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