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STEPS TO GUIDE SBIRT IMPLEMENTATION IN EMERGENCY DEPARTMENTS

There are five basic steps to the SBIRT implementation process. Beginning April 27, 2011, a series of five one-hour Web seminars will guide you through step-by-step implementation, and help you develop a site-specific project plan tailored for your emergency department. We recommend that you establish an implementation team comprised of individuals who will be involved in decision-making about your SBIRT project.

To get started, you can download the 2008 ENA SBIRT Toolkit  which provides you with supplemental information and resources that will help facilitate SBIRT implementation. We have updated the 2008 version by segmenting the tookit components into the five-step implementation process described below. By following these steps, you will have everything at your fingertips as you progress through the course of your project.

The five progressive steps in the SBIRT implementation process are:

1. Define evidence-based SBIRT implementation
2. Assess ED and staff readiness to implement SBIRT
3. Develop a site-specific action plan with outcome measures
4. Implement an outcomes-based action plan
5. Evaluate SBIRT progress and make improvements


OVERVIEW OF IMPLEMENTATION MODULES 1 THROUGH 5

MODULE 1. DEFINE your mentor role and project goals

Getting started on any new project can often be intimidating especially when you are trying to fit in this new project with all of the other required tasks throughout the course of your day. In this toolkit, ENA has developed shortcuts and summaries for providing you with enough background information on implementing SBIRT in emergency department to prepare you for the project at hand. Remember, in order to effectively assess your department’s situation and develop a realistic plan, as project leader you must educate yourself on the currently available information about SBIRT implementation. ENA has summarized the latest information and will provide you with the tools you need to be well-informed on this issue as you progress through the steps of your project.

In keeping with providing you with as many useful tools as possible, ENA has made the resources multifunctional so you can use them in multiple ways. For example, you can use elements of the ENA SBIRT Toolkit as a resource for your own professional development. Once you are familiar with the toolkit, its components (e.g., PowerPoint presentation, video, pocket card) might also be used to educate emergency department staff, hospital administrators, and other stakeholders.

MODULE 2. ASSESS ED and staff readiness to implement SBIRT 

In order to develop a focused, directed plan for SBIRT implementation, the project leader(s) or SBIRT implementation team should complete a thorough assessment of the current capacity of your emergency department to begin the process. There are many important considerations and addressing challenging issues early on, will help to achieve successful outcomes right from the start. So, figure out what issues need to be resolved and then direct your plan to those items that need the most attention first. This toolkit provides a number of sample assessments to help you through the assessment phase.

Keep in mind that assessment tools can be tricky. They need to represent an objective collection of information, but in this instance, staff perceptions and attitudes toward alcohol use and misuse, which are very subjective, are important too. Studies report that staff attitudes can be a barrier to conducting screening and brief interventions. Thus, conducting an assessment of both the emergency department and staff are important to understanding the major issues in any given emergency department.

You’ll find a variety of tools and summary forms in this section of the toolkit to help you develop a snapshot of what the major issues are in your emergency department and lead you to the areas of improvement you would like to focus on in your action plan. Use these tools as they are or modify them to serve the assessment needs of your department, taking into account the work and community culture in your setting. Targeted improvements identified in this step will be used to create an action plan that is tailored to the specific ED environment, capacity, and commitment to implement SBIRT.

MODULE 3. PLAN/DESCRIBE desired outcomes and action plan
Defining exactly where you want to go is an essential step in getting there successfully. Choosing relevant outcomes helps project planners describe exactly what they hope to accomplish. A good starting point is to use the results of the physical, cultural, and educational assessment performed in the previous step. An objective can be developed from an identified gap or area specified for improvement. When you develop your plan, be practical. Outcomes should be SMART; that is, specific, measurable, agreed upon, realistic, and time-bound so that you have a frame of reference for evaluating your progress. In this section, the toolkit will provide worksheets for drafting your customized outcomes list for your emergency department. Since there is no “one-size-fits-all” approach to the SBIRT implementation process, action plans should be specifically tailored to capabilities, resources, and needs of each emergency department and the surrounding community to which emergency services are provided. ENA has compiled a list of the most common outcomes for you to use as a reference and template for developing an action plan.


MODULE 4. IMPLEMENT your action plan

The goal of the SBIRT Mentorship Project is to facilitate the implementation process, but each facility will progress at its own pace. Action items are practical interventions and activities that your department can execute to help you achieve the specific outcomes you outlined in Step 3. In this module, we'll explore a range of activities related to specific outcomes that will help to facilitiate your emergency department’s action plan for SBIRT implementation. The key is to choose action items that are realistic for what is achievable in your department and not overwhelming in number or scope. A clearly articulated plan helps gain the support of staff and administration alike.


MODULE 5. EVALUATE progress and assess areas for improvement

Whether the SBIRT procedure is partially or fully implemented in any given emergency department, evaluation is critical at every step. Once the action plan has been carried out over a specified period of time (e.g., three months), it is important to take a closer look at whether progress has been made, to what extent the expected outcomes have been met, and whether adjustments to your plan are needed. This important step is what turns an action plan into an ongoing cycle of improvement. When evaluating progress, it is important to be able to quantify the activities that occur both before and after applying your action plan. This toolkit will provide uniform assessment tools and evaluation templates to help summarize the results of your emergency department’s SBIRT implementation process and identify areas for improvement. For long-term sustainability, it's important to present your findings to administration and staff so they are informed of project outcomes. A summary of results should include any existing challenges and recommendations for quality improvements, so that you establish ongoing project support and successful outcomes.