Individual and organizational determinants of alcohol screening and brief intervention implementation in emergency departments (SIPS-ED)

Objectives: This study explored individual and organisational barriers to and facilitators of effective implementation of alcohol screening and brief intervention in 9 Emergency Departments (EDs). This study was part of a large UK research programme on Screening and Intervention Programme for Sensible Drinking (SIPS). Methods: Nine EDs were recruited in three regions of England and 282 ED staff (mean 31.3 per ED; range 8–82) were trained in the study and intervention procedures. ED staff were required to deliver one of three screening tools and one of three brief interventions. All staff received appropriate training and support. Staff attitudes were measured before (T1) and straight after training (T2) as well as post implementation (T3) using the Short Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ). Additional questions on organisational factors affecting the implementation of SBI were asked at T2 and T3. Data were also collected to measure the performance of screening and delivery of intervention in each setting. Results: While staff were keen to be trained and while their attitudes and motivations significantly improved after training (p <.o1), there were several barriers to implementation which limited SBI activity across most settings, including workload pressures, lack of time, perceived lack of importance of alcohol in ED, high staff turnover, other competing priorities and feeling forced to take on extra work. Only 3 of 9 EDs were able to implement the protocol without additional input from the research team beyond training and regular support. In the remaining EDs it was necessary to deploy researchers and Alcohol Health Workers to complete screening and intervention. Successful sites were noted to have a keen ‘clinical champion’ who prioritised the screening and brief intervention activity, voluntary participation of ED staff, supportive managers, and a small number of core staff who were keen to participate and able to be engaged by the research team. Training large numbers of staff yielded less screening and intervention activity. Conclusions: Implementation of SBI in ED will be difficult in clinical practice due to the exigencies of ED care, and is likely in most cases to require delivery by dedicated outside specialist alcohol staff. Successful implementation also depends on local clinical and managerial champions and having a small number of dedicated staff who have responsibility for delivery of SBI.