Play 9: Flow

Flow

This is the nuts and bolts of how S·BI·RT will actually happen at your specific site:

How exactly will the screening occur? On paper? On a tablet?
Who does the screening? MA? RN? Provider?
When and where is the screening done? During the visit in the exam room? Before the visit in the waiting room?
How is the screening documented in the EHR?
Who is scoring the screening and how are the results of the screening reviewed?
Who/How is next step determined? (BI? RT to behavioral health provider?)

Purpose of Play 9	To determine the physical who, what, when, where and how of all S·BI·RT components.
Definitions	The flow is the logistics of the encounter and the entire S•BI•RT process. It identifies the roles and responsibilities of each staff person, in addition to the logistics of how and when screening, brief intervention, and/or referral to treatment is done and documented.
Team members	The entire team at each site needs to discuss and analyze flow, test the proposed flow with “walk-throughs,” and modify as necessary.
Measure(s)	Incorporation of new flow into daily practice. Depending on your practice setting, this may become part of your policies and procedures.

Map current flow for annual visits (or other visits at which screenings occur).
Discuss what works and what doesn’t. How will your incorporation of S•BI•RT processes capitalize on what works well and become an opportunity for quality improvement?
On another piece of paper, map out potential S•BI•RT flow – who can do what, when, where and how, and who can be responsible for what parts? Examples of flow charts are available in Appendix R.
Screening should be done before the visit in a place that provides privacy.
Walk through as a mock patient to test the potential S•BI•RT flow as the initial Plan-Do-Study-Act (PDSA) cycle.
Then pilot with a subset – perhaps one provider team – do PDSA cycles, that is, trial how this will work and revise until it works as you need it to. Then set a target implementation date.
Capitalize on multiple opportunities to educate all staff (See Play 14: Training) on the new flow until it is part of daily practice.

The research base for the impact of Brief Intervention is that it is most effective when it is delivered by the healthcare practitioner (See Play 6: Brief Intervention).
Embedding all S·BI·RT components into the EHR is optimal.
Working from existing flow patterns and protocols as much as possible aids sustainability.