Screening is an important part of any strategy to providing comprehensive care to substance use disorder patients in the ED setting. While some patients may self-report or come to the ED because of an overdose, many may go unnoticed with withdrawal symptoms that can look like many other illnesses. Standardized, evidenced-based screening tools not only identify patients with substance use disorder, but also provide an initial profile on the severity of the illness. Start with brief screens, such as SBIRT or TAPS for patients who are identified by symptoms, history, or other factors for substance use. If your ED would like to implement universal screening, see trailblazer protocols.  Key Takeaways for the ED

1. Develop protocols for when and how a patient will be administered a screen for substance use disorder. With input from clinicians, consider a constellation of symptoms that may trigger a screening.
2. Consider how to build the screen into your EMR and integrate into existing workflows to ease documentation burdens and increase continuity of care. 
3. If your hospital employs peer support specialists, include them in the development of the screening process to be used in the ED. While it is not necessarily appropriate for peers to administer the screen, peers have a deep knowledge of common withdrawal symptoms that may be misdiagnosed by emergency providers (EPs).  
4. Identify screening tools for both adults and youth, as youth are a demographic of patients who are vulnerable for substance use disorders. 
5. Not all patients who exhibit signs and symptoms related to substance use disorder will meet clinical criteria for a diagnosis. In that case, interventions may still apply and be relevant for their care. Similarly, not all individuals who present to the ED are presenting with the primary complaint of their substance use disorder. Once substance use disorder is assessed, it can be easy to make the entire visit about this aspect of the patient rather than their presenting problem. Simply put, it is imperative the patient be seen as a whole person rather than their substance use.  

Resources to Get You Started 

A comprehensive list of screening and assessment tools developed by The National Institute on Drug Abuse 

Clinician tools, patient education, and self-paced training on SBIRT through the University of Missouri-Kanas City (UMKC) School of Nursing and Health Studies  

Questions to Assess for OUD based on DSM-5 Criteria  Return to Table of Contents