AI Article Synopsis
- Routine screening for hazardous alcohol use in the emergency department (ED) misses many patients, largely due to factors related to patients and healthcare staff.
- During a study involving over 28,000 ED patients, 35% were not screened for hazardous alcohol consumption, with most missed cases occurring because staff forgot or patients were unable to cooperate.
- Patients with risk factors—like being male, having an alcohol-related visit, or experiencing trauma—were significantly less likely to be screened, indicating a concerning oversight that may put those patients at higher risk for hazardous alcohol use.
- The findings emphasize the need for improved screening processes, particularly for patients who are more vulnerable or unable to participate in screenings.
Article Abstract
Background: Routine screening programmes for hazardous alcohol use in the ED miss large numbers of patients. We investigated whether patient-related or staff-related factors cause screening failures and whether unscreened patients are at increased risk of hazardous alcohol use.
Methods: This is a secondary analysis of a prospective study. From November 2012 to November 2013, all adult patients visiting a Dutch inner city ED were screened for hazardous alcohol consumption using the Alcohol Use Disorders Identification Test-Consumption. Reasons for failure of screening were categorised as: (A) patient is unable to cooperate (due to illness or pain, decreased consciousness or incomprehension due to intoxication, psychiatric, cognitive or neurological disorder or language barrier), (B) healthcare professional forgot to ask, (C) patient refuses cooperation and (D) screening was recently performed (<6 months ago). Presence of risk factors for hazardous alcohol use was compared between screened and unscreened patients.
Results: Of the 28 019 ED patients, 18 310 (65%) were screened and 9709 (35%) were not. In 7150 patients staff forgot to screen, whereas 2559 patients were not screened due to patient factors (2340 being unable and 219 unwilling). Patients with any of these risk factors were less likely to be screened: male sex, alcohol-related visit, any intoxication, head injury, any kind of wound and major trauma. In multivariate analysis, all these risk factors were independently associated with not being screened. Patients with at least one risk factor for hazardous alcohol use were less likely to be screened. Highest prevalence of risk factors was found in patients unable or unwilling to cooperate.
Conclusion: Patients who do not undergo routine screening for alcohol use at triage in the ED have an increased risk for hazardous alcohol use. These data highlight the importance of screening patients, especially those initially unwilling or unable to cooperate, at a later stage.
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| http://dx.doi.org/10.1136/emermed-2019-208721 | DOI Listing |
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