PDSA Cycle for Putting SBIRT Procedures in Place

Plan

• Determine how you will incorporate SBIRT into your office flow. The workflow should identify by whom, how, when, and where screening will take place. In some practices, the workflow may delineate a handoff from the staff member responsible for screening to the physician equipped to assess screening results and conduct the brief intervention or referral to treatment.
• Select a recommended screening tool designed for adolescent substance use. Consider trying out different ones to see how they impact office workflow and fit with your practice style.
• Establish your office’s confidentiality practices to ensure patient privacy of screening test results and information discussed during visits and follow-up care.
• Establish documentation processes for SBIRT activities such as the following:
  • Screening result, including abstinence or frequency and risk level
  • Brief intervention conversation that ensued
  • Educational materials provided and discussed
  • Behavior change goals, if set
  • Follow-up plan, as applicable and which is timely
  • Recall/reminder alerts to verify those referred have established care or follow-up
• Determine staff roles and responsibilities. You may want to identify a champion to lead the practice in establishing SBIRT procedures and conducting PDSA cycles.
• Train providers and staff on SBIRT techniques and provide ways for them to demonstrate confidence in SBIRT (eg, role-play exercises).
• Identify educational materials to share with patients and families on substance use risk and prevention.
• Identify and develop relationships with substance use treatment services so you can match referrals to patients’ needs.
• Establish billing and payment procedures for screening and office-based brief intervention services.

Do

• Pilot the processes you have laid out.
• Use the selected screening tool in practice, giving staff a chance to practice their knowledge and skills and evaluate the tool’s feasibility for your practice and patients.

Study

• Gather feedback from staff on all aspects of SBIRT. What worked? What did not work?
• Use the information gathered to help refine and improve your processes.
• Stay current with substance use screening, intervention, and treatment for adolescents.
• Learn from others. Talk with other practices and members of your AAP chapter or district or members of the Committee on Substance Use and Prevention about their experiences and what is working for them.

Act

• Implement changes that resulted in success.
• Standardize improvements and begin to use them regularly.
• Consider formalizing processes as an office policy/ procedure document.
• After some time, return to stage 1, Plan, and re-examine SBIRT processes to learn where they can be further improved. The value of the PDSA cycle is the continuous search for improvement.