Using screening tools for various substance use problems in the ED can be powerful but can also be time consuming and costly and may require additional staff resources. Some studies suggest that computerized screening may be a solution to this dilemma because they require less staff time and allow scores to be calculated with fewer errors. As tablet computers have become lighter and less expensive and have a longer battery life, screening ED patients with these devices may improve delivery of care.
Over the past decade, opioid prescription abuse in the United States has increased exponentially, with deaths from overdose rising to epidemic proportions. In a study published in the Western Journal of Emergency Medicine, Scott G. Weiner, MD, MPH, and colleagues evaluated the feasibility of using an electronic tablet version of a screener for opioid prescription abuse potential in the ED. The authors used the Revised Screener and Opioid Assessment for Patients with Pain (SOAPP®-R), a proprietary screening measure that was previously developed and validated in pain clinic patients.
For the study, 93 adults being considered for ED discharge with a prescription for an opioid were approached and 82 consented to participate. “All patients completed the screening without assistance and no additional staff resources were required,” says Dr. Weiner. “The median time to completion was just 148 seconds, and 95% completed the screening in less than 5 minutes. In addition, 93% of patients rated the ease of completion as very easy. Our results demonstrate that it is feasible to electronically administer a screening tool for opioid abuse potential to ED patients in a time-efficient manner.”
According to Dr. Weiner, one of the concerns at the onset of the study was the truthfulness of patients who used the SOAPP®-R screening tool. “It can be easy for patients to simply select the same answer for each question or not answer honestly,” he says. “However, about one-third of patients had scores that were indicative of being at-risk for opioid abuse. This suggests patients were most likely being truthful.” That said, participants were told that the results were not going to be shared with their treating clinician. If they had been shared, results may have varied.
Some studies have described downsides to adopting technology as screening tools, highlighting the fact that what is feasible in one hospital may not work for others. However, the study findings support the notion that patients are willing and able to interact with tablet computers in the ED and find them easy to use. “The next step is to develop tools that are specific to EDs for screening for opioid abuse,” Dr. Weiner says. “Using screening technology may help reduce the burden of opioid abuse in the U.S.”
Readings & Resources (click to view)
Weiner SG, Horton LC, Green TC, Butler SF. Feasibility of tablet computer screening for opioid abuse in the emergency department. West J Emerg Med. 2015;16:18-23.
Weiner SG, Griggs CA, Mitchell PM, et al. Clinician impression versus prescription drug monitoring program criteria in the assessment of drug-seeking behavior in the emergency department. Ann Emerg Med. 2013;62:281-289.
Butler SF, Fernandez K, Benoit C, et al. Validation of the revised Screener and Opioid Assessment for Patients with Pain (SOAPP®-R). J Pain. 2008;9:360-372.
Ranney ML, Choo EK, Wang Y, et al. Emergency department patients’ preferences for technology-based behavioral interventions. Ann Emerg Med. 2012;60:218-227.
Benaroia M, Elinson R, Zarnke K. Patient-directed intelligent and interactive computer medical history-gathering systems: a utility and feasibility study in the emergency department. Int J Med Inform. 2007;76:283-288.