Call for structured approach to identify patients at high risk
American College of Surgeons trauma standards now require a screening and referral process to identify patients at high risk of psychological sequelae of the trauma.
But how are trauma centers meeting this requirement, asks the Academy’s Division Directors’ group?
On the group’s listserv, chair Brian Bronson, MD, poses the question following issuance of the college’s 2022 standards.
Some group members with trauma centers at their institutions conduct psychiatric social worker debriefing of patients, but without a standardized screener; others have embedded psychologists or psychiatrists in their trauma services, and others have no dedicated staffing or procedures in place—but aim to implement a meaningful process.
The standards are published in the college’s Resources for Optimal Care of the Injured Patient, and focus on mental health and alcohol misuse screening.
Mental health screening
All trauma centers, say the college, must meet the mental health needs of trauma patients by having:
Level I and II trauma centers should have a structured approach to identify patients at high risk for mental health problems, while Level III trauma centers are required to have a means of referral should a problem or risk be identified during inpatient admission.
Alcohol misuse screening
All trauma centers should screen all admitted trauma patients over 12 years old for alcohol misuse with a validated tool or routine blood alcohol content testing, say the college. Programs should achieve a screening rate of at least 80%.
Screening methods are at the discretion of each individual center. The college’s own Alcohol Screening and Brief Intervention for Trauma Patients tool is here (the screening references are on pages 107-109).
In all trauma centers, at least 80% of patients who have screened positive for alcohol misuse should receive a brief intervention documented by appropriately trained staff prior to discharge.
Level III trauma centers should have a mechanism for referral if brief intervention is not available as an inpatient.