New alcohol screening questions in EDs connect patients & care

Dorrie Fasick, RN, is the transformational lead with the IH Emergency Services Network. As Dorrie explains, before the new program was introduced into the EDs, only nine per cent of people were being screened for alcohol use disorder in the emergency. Of those nine per cent, only five per cent were being prescribed medications to treat AUD.

With this new program, when someone comes into the ED, there’s now a high likelihood they’ll be asked a few questions about their relationship with alcohol.

“It’s all about health care, and helping people with their health and wellness,” says Dorrie. “When someone walks in the doors, it’s impossible to know if they need help. It could be your 86-year-old grandma or your neighbour. It takes 30 seconds to screen someone.”

Dr. Aron Zuidhof is the medical director of IH Emergency Services. “In some ways the questions have always been there,” he says. “But this new program normalizes these conversations. We invite the patient to share or participate in any way they can and find out how we can help them.”

The program is designed to meet patients where they are at. Some patients might be ready to change their relationship with alcohol; some may not. If they don’t want to disclose anything, the nurse will move on.

At the very minimum, patients leave with resources like a pamphlet and contact information for substance use and counselling services.

“The goal isn’t to get people to stop using alcohol or abstinence,” explains Dorrie. “We gauge their interest and readiness for change. And if the patient isn’t ready to talk about it, that’s okay. There’s no pressure. There’s no shame. They’re given pamphlets with phone numbers, links and QR codes, and they can go home and think about it.”

If the patient does participate, the bedside nurse screens for the 4 C’s—cravings, loss of control, compulsions and consequences. This is the new part of the program: answering yes to any of the 4 C’s puts that person at risk for AUD. A doctor then consults with the patient to determine if they may be a candidate for prescription medication.

“Our work started around the time the new guidance on alcohol and health came out,” explains Dr. Zuidhof. “If someone doesn’t make the diagnosis for AUD, but is engaged in high-risk drinking, we have an opportunity to have a conversation and educate them as well.”

Thanks to the pioneering work of the late Dr. Jeff Harries of the Canadian Alcohol Use Disorder Society (CAUDS), medications that can curb cravings for alcohol and reduce withdrawal symptoms are becoming much more known and widely used.

“These medications are easy to prescribe and are effective at curbing cravings for alcohol,” says Dr. Zuidhof. “They are as effective as medications we use to treat heart attacks.”

Follow-up reports since the program was introduced are encouraging. After 30 days, 56 per cent of patients had filled prescriptions and after 90 days, up to 25 per cent were still taking their medication.

Patients who participate in the questions or get a prescription for AUD medication can expect a follow-up call from Interior Health within 72 hours. They can be connected with additional IH resources that may include a referral to the Virtual Addiction Medicine Clinic (VAM) or Outpatient Withdrawal Management—or whatever is appropriate for them.

“The VAM connection is especially important and beneficial to those who live in rural communities or don’t have a primary care provider. And they can use VAM for as long as they need it,” explains Dr. Zuidhof.

IH also has added new services and supports for patients and providers, including in-patient beds and outpatient, home-based services. “But we have a long way to go to equitably support the need,” admits Dr. Zuidhof.

The ED program was initially funded and supported by the IH Physician Quality Improvement Program. From the start, it was co-designed with patients, their families, Indigenous Partnerships and Peers with lived experiences.

“We acknowledge the colonial impacts of alcohol and how it was used to abuse and oppress the Indigenous communities,” says Dr. Zuidhof. “We wanted to be sure this program was designed through this trauma-informed lens.”

By asking permission from as many people as possible who walk in the doors of the ED to talk about alcohol in a compassionate, non-judgmental way, the goal is for no one to feel stigmatized, regardless of their background.

The work the IH team has done hasn’t gone unnoticed. In April, IH won the 2025 Solventum Health Care Innovation Team Award. The award recognizes IH’s disruptive approach to transforming care in emergency departments by streamlining care delivery, improving patient outcomes and alleviating pressure on the health-care system.

“Our work has been picked up provincially as well,” adds Dr. Zuidhof. “Emergency Care BC is looking at ways to spread innovative work across other health authorities.”

The team’s work was also featured in a recent podcast by Qualitycast North which showcases physicians and health-care workers.

But Dr. Zuidhof and Dorrie are both pragmatic about their success and the road that lies ahead.

“This isn’t one and done by any stretch,” says Dr. Zuidhof. “Culture change takes time.”

Dorrie adds, “It’s going to take a generation to change attitudes around alcohol. It’s just like any sea change: smoking, seat belts, drinking and driving.”

A few weeks ago, Dorrie struck up a conversation with a man in a park. Not knowing what she does for a living, he told her he’s a recovering alcoholic. “He’s a successful tech professional and no one outside of his family knew. He went cold turkey on his own and put himself at risk doing so. When I told him about the program, he felt it would have greatly helped him.

“Those are the people who weren’t being asked before in the ED about their relationship to alcohol, and now they will be.”

Alcohol is widely available, socially acceptable and for many, a natural part of our lives. But we may not often stop to consider its consequences.

Changing your relationship with alcohol is not about willpower or good intentions. There are many treatment options and help is available. Learn how you can receive help if you're struggling with alcohol use.

Help with Alcohol Use

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