A time and motion study of Screening, Brief Intervention, and Referral to Treatment implementation in health-care settings

Addiction. 2017 Feb;112 Suppl 2:65-72. doi: 10.1111/add.13659.


Aims: Screening and brief intervention for harmful substance use in medical settings is being promoted heavily in the United States. To justify service provision fiscally, the field needs accurate estimates of the number and type of staff required to provide services, and thus the time taken to perform activities used to deliver services. This study analyzed the time spent in activities for the component services of the substance misuse Screening, Brief Intervention and Referral to Treatment (SBIRT) program implemented in emergency departments, in-patient units and ambulatory clinics.

Design: Observers timed activities according to 18 distinct codes among SBIRT practitioners.

Setting: Twenty-six US sites within four grantees.

Participants: Five hundred and one practitioner-patient interactions; 63 SBIRT practitioners.

Measurements: Timing of practitioner activities.

Interventions: Delivery of component services of SBIRT.

Findings: The mean (standard error) time to deliver services was 1:19 (0:06) for a pre-screen (n = 210), 4:28 (0:24) for a screen (n = 97) and 6:51 (0:38) for a brief intervention (n = 66). Estimates of service duration varied by setting. Overall, practitioners spent 40% of their time supporting SBIRT delivery to patients and 13% of their time delivering services.

Conclusions: In the United States, support activities (e.g. reviewing the patient's chart, locating the patient, writing case-notes) for substance abuse Screening, Brief Intervention and Referral to Treatment require more staff time than delivery of services. Support time for screens and brief interventions in the emergency department/trauma setting was high compared with the out-patient setting.

Keywords: Alcohol; screening and brief intervention; substance misuse; time and motion study.

MeSH terms

  • Ambulatory Care Facilities
  • Cognitive Behavioral Therapy / methods*
  • Emergency Service, Hospital
  • Hospitals
  • Humans
  • Mass Screening / methods
  • Motivational Interviewing / methods*
  • Physician-Patient Relations
  • Referral and Consultation*
  • Substance-Related Disorders / diagnosis
  • Substance-Related Disorders / rehabilitation*
  • Time Factors
  • Time and Motion Studies
  • United States