Disseminating Organizational SBI Services at Trauma Centers

Each year in the United States approximately 2.5 million individuals are so severely injured
that they require inpatient hospital admission. The integration of screening and brief
interventions (SBI) into acute injury care has the potential to markedly increase the number
of patients who receive needed services and has been a longstanding public health objective.
In January of 2005 the American College of Surgeons, the primary agency responsible for
developing trauma center requirements, passed a landmark resolution mandating that level I
trauma centers must screen injured patients for an alcohol use disorder, and provide an
intervention to those who screen positive. Preliminary studies suggest that there is a
substantial risk that the SBI mandate will be implemented with marked variability and that
low quality SBI procedures could become the default standard of trauma center care.

Providers at each intervention trauma center will receive workshop training and ongoing
telephone coaching in the delivery of evidence-based motivational interviewing (MI)
intervention; MI training will be embedded within evidence-based organizational development
activities that aim to facilitate the integration of SBI services into routine trauma center
care. Control trauma centers will implement SBI care as usual. The investigation hypothesizes
that intervention trauma centers, when compared to control trauma centers, will demonstrate
higher quality SBI, as evidenced by greater provider proficiency in SBI delivery, significant
reductions in 6- and 12-month post-injury alcohol use in patients receiving SBI, and enhanced
organizational acceptance of SBI services. Without DO-SBIS baseline data on SBI services and
follow-up RCT data on patient, provider, and organizational outcomes, a critical opportunity
to provide empiric support of a historic policy decision to require alcohol services at level
I trauma centers could be lost. The DO-SBIS interdisciplinary research group includes trauma
surgery opinion leaders who are dedicated to implementing future policy mandates that derive
from the DO-SBIS research program. Future mandates will aim to strengthen and refine trauma
center delivery of evidence-based SBI services. The dissemination of high quality SBI
services at level I trauma centers has the potential to influence alcohol policy in other
health care settings nationwide.

Inclusion Criteria:

- For provider subjects: staff at trauma centers selected by study

- For patient subjects: admitted to trauma centers selected by study, positive blood
alcohol levels, able to provide two follow-up contacts

Exclusion Criteria:

- For Providers: Once a trauma center is selected for participation, providers will be
selected from existing hospital staff.

- For Patients: Patients so severely injured that they cannot participate in study
procedures will be excluded;

- Patients who are admitted after self-inflicted injury, or are psychotic and therefore
require more intensive acute interventions, will not be included in the study;

- Injured hospitalized prisoners are excluded.

- Children under the age of 18 are excluded.