A time and motion study of screening, brief intervention, and referral to treatment implementation in health-care settings

Abstract

Aims Screening 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. Design Observers timed activities according to 18 distinct codes among SBIRT practitioners. Setting Twenty-six US sites within four grantees. Participants Five hundred and one practitioner-patient interactions; 63 SBIRT practitioners. Measurements Timing of practitioner activities. Interventions Delivery of component services of SBIRT. Findings The 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. Conclusions In 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 requiremore 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.