Emergency departments

The emergency departments component of the BC alcohol and other drug monitoring project identified and monitored emerging trends in patterns of alcohol and other drug use that increase the risk of injury, overdose, poisoning, and other acute harms.

Key findings from this component can be found in facts & stats/substance use and emergency room visits.

Methodology

This study, that is now complete, recruited patients who came into the emergency department (ED) on Friday or Saturday night between 9 p.m. and 4 a.m. Data was collected at two EDs in British Columbia (Royal Jubilee Hospital in Victoria and Vancouver General Hospital in Vancouver) on one Friday night and one Saturday night each month. This population was selected because it is known to have a high rate of prior psychoactive substance use contributing to injury or illness. The ability to monitor the proportion of ED patients who use or misuse substances, the characteristics of their substance use and related harms may therefore serve as an early warning system for substance problems in the greater population.

A pilot study was conducted on 97 patients early in 2008 to test the survey instruments and protocol. As a result, improvements were made to the sampling strategy, the survey instruments, the study protocol and the consent form. Four waves of survey data collection were completed in both sites: 2008, 2009, 2010 and 2011. Data collection for this study stopped in September of 2011.

This monitoring study used ICD-9 because one of our study sites is still using this version of the diagnostic categories in their emergency department. In addition, information obtained from patients in a busy ED is not specific enough to code for the more detailed ICD-10 conditions.

Inclusion criteria

Interviewees who were between 17 and 75 years of age, could speak and understand English and could provide informed consent were asked to participate. Each respondent completed an interviewer-administered survey, a breathalyzer test for blood alcohol concentration (BAC) and a saliva test for metabolites of other drugs.

Instruments

Patients who consented to be in the study were interviewed using a standardized survey instrument. The survey consisted of questions pertaining to the reason for ED visit, the participant’s drug use history (lifetime use, past 12 months, one month, one week, and yesterday), including specific alcohol use, cannabis use, and injection drug use. There were questions pertaining to drug-related harms and to alcohol or drug use in the six hours prior to onset of symptoms/injury. Survey instruments were developed for each site: Royal Jubilee Hospital and Vancouver General Hospital.

BAC and saliva tests

Participants also consented to a breathalyzer test and a saliva drug test. The breath test uses the Alco-sensor IV breathalyzer. For the breathalyzer test, a subject blows into a sterile disposable mouthpiece for 5 to 10 seconds and the machine automatically estimates the BAC. A saliva/sweat drug test was administered, using a Securetec detektions-systeme AG drugwipe5 five-drug sensing test strip. This is a self-contained testing strip which displays the presence of metabolites of drugs via the development of coloured lines in the strip's detection zone: amphetamine-like substances (including amphetamine, methamphetamine, ecstasy), cocaine, opiates (heroin and morphine) and cannabis.

Locations and partnerships

Two locations were used for this study – Vancouver General Hospital (VGH) in Vancouver and Royal Jubilee Hospital (RJH) in Victoria. VGH is the largest hospital in British Columbia and the major tertiary referral centre for the province. Services in all adult areas of medicine except obstetrics are provided at this site. RJH is one of two tertiary hospitals serving Vancouver Island (Victoria General Hospital is the other). These hospitals operate as one large facility across two sites, providing high-level trauma care and specialized services.

Securing these locations was been made possible by having direct collaboration with key ED medical staff at each site. Dr. Andrew MacPherson at RJH and Dr. Jeff Brubacher at VGH have been instrumental in moving this project forward.

Team

Tim Stockwell
Kate Vallance

Related publication

Surveillance systems and trauma care: What can be done in the ED? (PDF 319kb) Chapter 12 in Prevention of alcohol-related injuries in the Americas