Date Published: June 5, 2013
Publisher: BioMed Central
Author(s): Regina Makdissi, Scott H Stewart.
There is increasing emphasis on screening, brief intervention, and referral to treatment (SBIRT) for unhealthy alcohol use in the general hospital, as highlighted by new Joint Commission recommendations on SBIRT. However, the evidence supporting this approach is not as robust relative to primary care settings. This review is targeted to hospital-based clinicians and administrators who are responsible for generally ensuring the provision of high quality care to patients presenting with a myriad of conditions, one of which is unhealthy alcohol use. The review summarizes the major issues involved in caring for patients with unhealthy alcohol use in the general hospital setting, including prevalence, detection, assessment of severity, reduction in drinking with brief intervention, common acute management scenarios for heavy drinkers, and discharge planning. The review concludes with consideration of Joint Commission recommendations on SBIRT for unhealthy alcohol use, integration of these recommendations into hospital work flows, and directions for future research.
Alcohol-related problems constitute a tremendous economic and health cost in many countries throughout the world [1,2]. Screening, brief intervention, and referral to treatment (SBIRT) has become one of the major tools used to combat these problems, and is widely recommended for use in primary care by governments and expert panels [3,4]. Recently, the Joint Commission on Accreditation for Health Care Organizations (JCAHO), the major accrediting body for hospitals in the US, has advanced SBIRT as a quality indicator for general hospital care . There is no doubt that alcohol problems are a critical issue in hospital care, but there are concerns that the evidence base does not yet justify widespread SBIRT in this setting . This review will consider the nature of unhealthy alcohol use in the general hospital, review means for detecting unhealthy use and categorizing severity, consider the evidence on the effectiveness of SBIRT in the hospital setting, briefly review acute treatment issues, and discuss factors affecting the implementation of SBIRT into general hospital workflows. The goal is to provide an overview of the field that will aid hospital-based clinicians and administrators in their consideration of policies and procedures that will yield the highest quality care for their patients. In this regard, the impact of detecting and treating unhealthy alcohol use is one of many important health care issues that must be evaluated.
Unhealthy alcohol use is common in hospitalized patients, with a high prevalence of severe alcohol problems among those with unhealthy use. Detection should include the use of a validated screening instrument to determine the presence of unhealthy use, and assessment of alcohol-related consequences in patients with positive screening results to categorize the severity of unhealthy use. Based on current evidence, patients without an alcohol use disorder should receive a brief intervention to target reduced drinking. Acute care issues for patients with alcohol use disorders have been well described and are standards of care. Additional research is needed to guide discharge planning for inpatients with an alcohol use disorder, but management should include referral to outpatient addiction treatment if available, consideration of medications to prevent a return to heavy drinking, and explicit follow-up on alcohol use in the ambulatory medical setting. JCAHO has advanced SBIRT for unhealthy alcohol use as a quality measure, and barriers to implementation are mainly generic factors rather than specific to SBIRT. Continued research is needed across the spectrum of unhealthy alcohol use to further demonstrate the benefits of hospital-based SBIRT, refine the process, and improve care for hospitalized patients.
The authors declare that they have no competing interests.
RM and SHS each reviewed the literature and participated in drafting the manuscript. Both authors read and approved the final manuscript.