Identification and Referral of Impaired Drivers through Emergency Department Protocols

NHTSA - Behavioral Safety Researchhttps://doi.org/10.21949/15255202002PDFResearch PaperRunge, J. W.Garrison, H.Hall, W.Waller, A.Shen, G.Carolinas HealthCare SystemUnited States. National Highway Traffic Safety Administration. Office of Research and Traffic Records. Research and Evaluation DivisionUnited States. Department of Transportation. National Highway Traffic Safety AdministrationUnited StatesHospital emergency roomsAlcohol abuseAlcoholismDrunk drivingCase studiesImpaired drivingAlcoholDOT-HS-809-412DTNH-22-97-DH-15072Walker, Jon; Berning, AmyFinal reportOf patients treated in the emergency department (ED) following a motor vehicle crash (MVC), 15-20% are at high risk for alcohol abuse or alcohol dependency (AA/AD), and are likely to drive after drinking. In order to intervene with patients at high risk in the ED, a reliable and quick screening procedure and a method of intervention must be available. This study investigated whether an ED intervention protocol to identify and refer patients with AA/AD would result in more patients receiving treatment and evaluation for substance abuse. The prospective, randomized, controlled study was performed at two EDs with a combined census of 120,000 patients of driving age. Consecutive patients over 17 years of age treated in the ED for MVC injury from 10 AM to 10 PM over a 1 year period were studied. Excluded were patients admitted greater than 24 hours, unconscious or too impaired to cooperate with the questions, and those who could not communicate in English. Patients were screened for AA/AD using a previously validated screening tool (TWEAK). Those at high risk of AA/AD were randomized to a group receiving the intervention protocol or to a control group (no intervention). The intervention protocol was a standard scripted protocol used by all interviewers, ending with a recommendation for definitive evaluation and treatment. Patients were followed up by phone at 3 and 6 months. Groups were compared to determine the likelihood of actually receiving treatment for AA/AD. Of those receiving the intervention, 25 out of 130 (19.2%) received a formal evaluation, compared to 7 out of 157 (4.5%) in the control group [OR=5.1, 95%, CI=2.128-12.235]. Of those persons who agreed to an evaluation, 21 out of 43 (48.8%) showed up for the evaluation. The conclusion of this study was that an ED protocol for screening and intervention for patients at high risk of AA/AD increases the likelihood of receiving definitive treatment for AA/AD. /Abstract from report summary page/129