A time and motion study of Screening, Brief Intervention, and Referral to Treatment implementation in health‐care settings

• DOI: 10.1111/add.13659
• Publication Date: 2017-01-13T10:06:31Z
• Authors: Alexander J. Cowell; William N. Dowd; Justin Landwehr; Carolina Barbosa; Jeremy W. Bray
• Keywords: Physician-Patient Relations; Time Factors; Cognitive Behavioral Therapy; Substance-Related Disorders; 610; Motivational Interviewing; Ambulatory Care Facilities; Hospitals; United States; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Time and Motion Studies; Humans; Mass Screening; Emergency Service, Hospital; Referral and Consultation

AbstractAimsScreening and brief intervention for harmful substance use in medical settings is being promoted heavily in the United States. To justify service provision fiscally, the field needs accurate estimates of the number and type of staff required to provide services, and thus the time taken to perform activities used to deliver services. This study analyzed the time spent in activities for the component services of the substance misuse Screening, Brief Intervention and Referral to Treatment (SBIRT) program implemented in emergency departments, in‐patient units and ambulatory clinics.DesignObservers timed activities according to 18 distinct codes among SBIRT practitioners.SettingTwenty‐six US sites within four grantees.ParticipantsFive hundred and one practitioner–patient interactions; 63 SBIRT practitioners.MeasurementsTiming of practitioner activities.InterventionsDelivery of component services of SBIRT.FindingsThe mean (standard error) time to deliver services was 1:19 (0:06) for a pre‐screen (n = 210), 4:28 (0:24) for a screen (n = 97) and 6:51 (0:38) for a brief intervention (n = 66). Estimates of service duration varied by setting. Overall, practitioners spent 40% of their time supporting SBIRT delivery to patients and 13% of their time delivering services.ConclusionsIn the United States, support activities (e.g. reviewing the patient's chart, locating the patient, writing case‐notes) for substance abuse Screening, Brief Intervention and Referral to Treatment require more staff time than delivery of services. Support time for screens and brief interventions in the emergency department/trauma setting was high compared with the out‐patient setting.