Effects of a structured SBIRT training program for hospital nursing leaders on utilization of SBIRT within their medical-surgical units: cohort study

Abstract

Background: Psychoactive substances contribute to numerous deaths annually, and more than 60% of the US population aged 12 + years reports past-month substance use. Screening, brief intervention, and referral to treatment (SBIRT) may support identification of substance-related risks and facilitate targeted interventions, but best practices and implementation designs remain elusive. Our study examined whether a standardized SBIRT toolkit and training-of-trainers for nurse site coordinators was prospectively associated with documented performance of core SBIRT-related functions in medical-surgical hospital units. Methods: This was a prospective cohort study conducted from January 2018 to May 2019 in 14 adult medical-surgical units (one/hospital). Hospitals were randomly allocated to two groups (n = 7 hospitals/each), which received identical interventions: an SBIRT training-of-trainers (8 h), supportive follow-up, and a toolkit containing information, resources, and guidance. However, group 1 sites were trained four months earlier than group 2 sites. At three points (baseline, 10-months, and 16-months), 61 patient records per hospital unit (n = 854) were randomly selected for extraction. Inclusion criteria for random selection were age (18+) and being admitted and discharged from the selected unit. Main outcome measures were analyzed using generalized linear mixed models, including screening within 24 h of admission, using a validated screening tool, screening positive, and receiving a brief intervention or referral to treatment. Results: For groups 1 and 2, patients had 1.81 and 2.66 greater odds, respectively, of being screened for alcohol at 10-months, 1.92 and 4.68 greater odds of being screened for drugs, and 1.96 and 2.06 greater odds of being screened for tobacco. For hospital group 2, patients also had greater odds of being screened for alcohol (3.92), drugs (6.31), and tobacco (2.41) at 16-months. For both hospital groups and benchmarks, patients were hundreds of times more likely to be screened with a validated tool, reflecting a shift from near absence of such behaviors (around 1% prevalence) to prevalence rates from 24 to 56%. Conclusions: The SBIRT intervention was associated with the initiation and sustained use of validated screening tools for alcohol and drugs, and with short-term increases in overall alcohol, tobacco, and drug screening prevalence.