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Surgeon helps to change regulations At least half of all patients admitted into trauma centers are under the influence of alcohol, a trend that MUSC would like to see reversed.   During an MUSC Ground Rounds sponsored by the Department of Psychiatry and Behavioral Sciences, Larry Gentilello, M.D., chief of Trauma and Critical Care at University of Texas Southwestern Medical School, outlined his goal with MUSC staff of reducing the number of trauma injuries and deaths in the nation by 50 percent, largely by addressing the implication of alcohol-related cases.   Between 40 percent and 60 percent of patients admitted to trauma centers are under the influence of alcohol, Gentilello said, adding that the majority of trauma patients are regular heavy drinkers with alcohol problems. Because little is being done to address this problem through detection or intervention, these patients continue to return to trauma. Unfortunately, their behavior often results in the injury or death of others.   Meanwhile, MUSC’s Center for Drug and Alcohol Programs, the Department of Surgery’s Division of Trauma and Critical Care, and the Department of Medicine’s Emergency Department are taking this issue very seriously. Ongoing clinical and research collaborations among these divisions are pursuing a multi-faceted attack on alcohol and trauma with the goal of dramatically reducing trauma injuries and death in the Lowcountry.   In his study, Gentilello conducted a randomized, controlled trial of more than 700 patients at Harborview Medical Center in Seattle, Wash. One group received brief alcohol counseling while in the trauma center while another group received no counseling. At the one year follow-up, the counseling group had decreased its alcohol consumption by an average of 22 drinks a week, with no change in drinking in the control group. During a three-year period, hospital readmissions were reduced by 47 percent trauma and 48 percent in injury-related emergency department visits for the patients who were counseled. Little change was observed in the non-counseled group.   Consequently, Gentilello lobbied fellow trauma surgeons and regulatory agencies, and as a result of his efforts, the American College of Surgeons Committee on Trauma (COT) now requires that Level I and Level II trauma centers to have a routine mechanism in place to identify problem drinkers. In addition, Level I centers must have the capability to provide brief interventions (10- to -15 minute advice and counseling sessions about drinking) for patients who screen positive for alcohol abuse. As an incentive, new billing codes as of January allow Medicare and Medicaid to reimburse health care facilities for alcohol screening and brief interventions.   Gentilello now is targeting the Uniform Accident and Sickness Policy Provision Law (UPPL), passed in 1947, which prevents trauma surgeons and emergency department physicians from asking patients about their alcohol use. It’s a matter of insurance. UPPL states that insurers are not liable for any loss sustained in any consequence of the insured’s being under the influence of alcohol or narcotics, meaning that if a patient is screened for alcohol and shows signs of heavy alcohol use, the insurance company doesn’t pay the bill. The laws must be repealed on a state-by-state basis. Friday, June 8, 2007 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island Publications at 849-1778, ext. 201.