Emergency Department Detection and Referral Rates for Patients with Problem Drinking

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Abstract
Alcohol-related problems cause 100,000 deaths annually, costing society more than $150 billion/year. This study was designed to establish provider detection and referral rates in a large inner-city Emergency Department, using three established measurement tools: the Ever a Problem (EAP), the four-question CAGE screen, and the QED Saliva Alcohol TEST (SAT). Two hundred ten patients met sample criteria; 172 (81%) were enrolled. Among those who were enrolled, 40% were positive on at least one measure: 13% on the SAT, 19% on the EAP, and 31% on the CAGE. The provider detection rate was high for SAT+ (intoxicated) patients (69.5%), but less so for those who were EAP+ and/or CAGE+ without an elevated SAT (32.6%). On retrospective record review, only 23.5% of those patients who were SAT+ and either CAGE+ or EAP+ could be shown to have been referred for treatment. We conclude that (1) the prevalence of alcohol problems is high in our ED setting (2) detection is possible with minimal disruption of the usual ED processing of care, and (3) significant opportunities for referral are currently being missed.