Michael A. Yokell

Opioid overdose is a leading cause of injury-related mortality in the United States.^1,2 However, little is known nationally regarding the characteristics of opioid overdose presentations to emergency departments (EDs).

Introduction: Emergency department (ED) screening and counseling for alcohol misuse have been shown to reduce at-risk drinking. However, barriers to more widespread adoption of this service remain unclear.Methods: We performed a secondary analysis of a nationwide survey of 277 EDs to determine the proportion of EDs that routinely perform alcohol screening and counseling among patients presenting with alcohol-related complaints and to identify potential institutional barriers and facilitators to routine screening and counseling. The survey was randomly mailed to 350 EDs sampled from the 2007 National Emergency Department Inventory (NEDI), with 80% of ED medical directors responding after receiving the mailing or follow-up fax/email. The survey asked about a variety of preventive services and ED directors’ opinions regarding perceived barriers to offering preventive services in their EDs.Results: Overall, only 27% of all EDs and 22% of Level I/II trauma center EDs reported routinely screening and counseling patients presenting with drinking-related complaints. Rates of routine screening and counseling were similar across geographic areas, crowding status, and urban-rural status. EDs that performed routine screening and counseling often offered other preventive services, such as tobacco cessation (P<0.01) and primary care linkage (P=0.01). EDs with directors who expressed concern about increased financial costs to the ED, inadequate follow-up, and diversion of nurse/physician time all had lower rates of screening and counseling and also more frequently reported lacking the perceived capacity to perform routine counseling and screening. Among EDs that did not routinely perform alcohol screening and counseling, more crowded than non-crowded (P<0.01) and more metro than rural (P<0.01) EDs reported lacking the capacity to perform routine screening and counseling. The capacity to perform routine screening also decreased as ED visit volume increased (P=0.04).Conclusion: To increase routine alcohol screening and counseling for patients presenting with alcohol-related complaints, ED directors’ perceived barriers related to an ED’s capacity to perform screening, such as limited financial and staff resources, should be addressed, as should directors’ concerns regarding the implementation of preventive health services in EDs. Uniform reimbursement methods should be used to increase ED compensation for performing this important and effective service. [West J Emerg Med. 2014;15(4):438-445.]

Trauma is the most common cause of years of life lost for those younger than 65 years, and it exacts $406 billion per year in costs, more than heart disease or cancer.^1,2 Acute care in specialized trauma centers has been shown to reduce mortality by 25% in patients with major trauma.³ While direct transport from the scene of injury to a designated trauma center is optimal, patients who are taken to non–trauma center emergency departments (EDs) and who are then transferred in a timely fashion to trauma centers have reduced mortality compared with those who are hospitalized at the non–trauma center.^4,5 Regionalized trauma systems have been developed during the past 3 decades to optimize population-level outcomes by facilitating the direct transport or transfer of patients with severe injuries to designated trauma centers.^6,7