Can screening and referral for posttraumatic stress improve mental health and substance abuse service delivery at trauma centers? Results from a randomized trial.

INTRODUCTION

American College of Surgeons Committee on Trauma (ACS/COT) policy now requires that United States trauma centers perform mandatory posttraumatic stress disorder (PTSD) screening and referral, as well as alcohol screening and intervention. Few investigations, however, have evaluated patterns of trauma center mental health and substance use inpatient service delivery.

METHODS

The investigation was a secondary analysis of a randomized clinical trial in which screening and referral practices mirrored ACS/COT policy requirements. Hospitalized physical injury survivors ≥18 years of age underwent screening for elevated levels of PTSD symptoms. Symptomatic patients were randomized to either enhanced usual care control or collaborative care intervention conditions. Patients randomized to the enhanced usual care control condition underwent PTSD screening followed by a study team orchestrated trauma surgery referral recommendation for mental health and/or substance use services. One or more inpatient referral suggestions were made for the Psychiatry Consultation Liaison, Rehabilitation Psychology, Social Work, Spiritual Care, and Alcohol Screening, Brief Intervention and Referral (SBIRT)/Addiction Medicine Consult services. Patients randomized to the intervention condition were screened and received care from a trauma center based collaborative care team that addressed mental health and substance use problems, but did not receive inpatient referrals. Electronic medical record review documented the frequency of mental health and substance use consulting service visits. Analyses determined if randomization status or referral significantly contributed to the likelihood of receiving inpatient services.

RESULTS

Enhanced usual care patients were significantly more likely to receive one or more visits from any service when compared to intervention patients (odds ratio (OR)=1.91, 95 % confidence interval (95 % CI) =1.05, 3.57). Study team referral suggestions were associated with an increased likelihood of Addiction Medicine Consult (OR=9.14, 95 % CI =3.36, 25.60) and SBIRT visits (OR=7.15, 95 % CI =3.33, 15.39) for enhanced usual care patients.

CONCLUSION

Usual care patients experienced significantly enhanced inpatient service delivery when randomized to procedures that mirror ACS/COT policy requirements. In the United States, ACS/COT screening, intervention, and referral requirements may be associated with improved quality of trauma center mental health and substance use service delivery.

CLINICAL TRIAL REGISTRATION: NCT03569878.