Screening for Our Safety (SOS):
Alcohol Screening in the Emergency
Department
AAA Foundation for
Traffic Safety
• Established in 1947
• 501 (c)(3) Not-For-Profit
• Research affiliate of AAA/CAA
• North American Focus
Mission
• Identify traffic safety problems
• Foster research that seeks solutions
• Disseminate information and
educational materials
Funded through the generosity of
and its members
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
Making the ED Part of the
Solution to Impaired Driving
1. Screening and brief interventions in
the ED
• Literature review
• Other research at our institution
– RIES project
– DIAL project
– REDUCE project
Making the ED Part of the Solution
to Impaired Driving
2. 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
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
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
Learning objectives for the curriculum
Increase knowledge about :
1. The usefulness of screening for alcohol
use problems with ED patients
2. Options available for patients who screen
positive for alcohol use problems
3. The significance of alcohol use and injury,
the prevalence of impaired driving in
Rhode Island, and mechanisms available
for reporting impaired drivers
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
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
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
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
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
Total Eligible Patients
Number of Charts reviewed
Patients Screened
Positive screened patients with
alcohol use further described
Positive screened patients who
received an intervention
Intoxicated patients (BAC>.08)
receiving an intervention
Precurriculum
172
92% (158)
85% (135)
57%
Postcurriculum
212
98% (208)
88% (183)
75%
p value
14% (5)
32% (10)
p=.04
33% (5)
66% (10)
p=.04
p=.47(ns)
p=.003
Objective measure of clinical practice
Figure 7: Number of physicians reports
to the Department of Motor Vehicles
from October 2004 to September 2005
# of Reports
42
17
17
10
10/04-12/04
1/05-3/05
4/05-6/05
7/05-9/05
Dates
Number of physicians reports for
alcohol impairment to Rhode Island
DMV Medical Review Board
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.
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
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
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
For more information,
please go to:
www.aaafoundation.org
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.