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Thu Aug 17 16:48:32 BST 2006

Rob,
You are so right - we are NOT social workers or psychiatrists or
psychologists.  We are the physician who needs to identify -through
screening - the patients that those folks can work with.
Ron

>>> <rfsmithmd at comcast.net> 8/17/2006 11:40 AM >>>
For several years we have screened all patients at County for substance
abuse, child abuse and domestic violence. We use CAGE, blood, urine and
a short "CAGE equivalent" set of questions for DV. There is a screening
form for Peds. It was kind of a struggle to implement this. Many of what
I had thought of as natural advocates were skeptical that I just wanted
to do research. Some people were afraid of harm to workers insurance. I
agreed that it made no sense to screen unless we had dedicated referral
resoures that could see the pts. either immediately or before discharge.
Because we were the only Department doing universal screening we were
able to get a grant supported substance abuse specialist who would
interview all the appropriate pts. and coordinate transfer directly into
a rehab type of setting. Before we had this resource, rehab follow up in
a delayed manner, no matter how short was zero. We also have a
separately funded group of DV specialists for the whole hospital. 
 It isn
't appropriate for regular providers to do anything other than screen.
We don't know what we're doing and can definitely do harm and put pts.
in danger.

R. Smith, MD

-------------- Original message -------------- 
From: "Ronald Gross" <Rgross at harthosp.org> 

> I applaud the ACS initiative, and would say only that it is about
time 
> that we moved on this. In fact, I am not sure why Level II Trauma 
> Centers have not been held to the same standards! 
> 
> In fact, the great State of Connecticut has a law that requires 
> "mandatory screening" of all admitted trauma patients. The problem
with 
> this is that (1) the screening method is left to the 
> institution/physician, and (2) the entire population seen in the ED
and 
> sent home is missed. We here at Hartford Hospital screen all ED
trauma 
> patients with, at a minimum, CAGE questioning. There are those of us
- 
> yours truly included - who test both blood and urine on every single

> trauma patient, whether admitted or not, and personally discuss the 
> results with the patient when they are positive for substance abuse.

> All patients found to have indications of abuse, whether by the very

> minimalist CAGE questioning, or the confirmatory laboratory testing,
are 
> then seen by our social service substance abuse counselors. 
> 
> We need to do more! 
> 
> Best wishes, 
> Ron 
> 
> >>> "Bjorn, Pret" 8/16/2006 8:19 AM >>> 
> According to Surgery News (Aug 06), the ACS is preparing to require 
> Level I trauma centers to perform alcohol abuse screening and 
> intervention for trauma patients. Do you screen and intervene? If 
> so, 
> how? If not, why not - and what are your thoughts on the new ACS 
> standard? 
> 
> Thanks. 
> 
> Pret Bjorn, RN 
> Bangor, ME USA 
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