Legal barriers to alcohol screening in emergency departments and trauma centers.

As described in more detail in the accompanying article by D’Onofrio and Degutis, many patients admitted to emergency departments (EDs) and trauma centers have positive blood alcohol levels at the time of their visit. (For more information on the dis­ tinction between EDs and trauma centers and the patients they treat, see the textbox “Emergency Departments Versus Trauma Centers.”) Research has shown that screening ED and trauma patients for alcohol use not only helps physicians make a more accurate diagnosis of patients’ conditions and decide on an appropriate treatment plans but also may allow for brief interventions and referrals to more extensive treatment. Many clinicians believe that patients with alcohol-related problems may be particularly amenable to alcohol interventions while they receive acute medical care for an alcohol-related injury. Several studies have demonstrated that brief interventions delivered to patients who are being treated in EDs or trauma centers for alcohol-related injuries can reduce alcohol consumption and the risk of renewed alcohol-related injuries in those patients (for more information, see the article by D’Onofrio and Degutis). Despite the apparent benefits of screening and brief interventions or referrals, only a portion of ED and trauma patients actually are screened for alcohol use and alcohol-related problems. One survey found that about two-thirds of trauma surgeons frequently deter­ mine the blood alcohol concentrations of their patients, but only 25 percent used formal screening question­ naires with some or all of their patients (Schermer et al. 2003). Thus, although the study’s authors noted an increase in screening over previous years, a large num­ ber of patients who could benefit from screening still are missed. It is important to note, however, that this survey was conducted among trauma surgeons, who are more likely to see severely injured patients than are ED