The Shot You Didn’t See Coming: Navigating the New ACS SBIRT Mandates.
Reviewing SBIRT (Screening, Brief Intervention, and Referral to Treatment) requirements through the lens of the ACS (American College of Surgeons) feels a bit like being told you need to perform a perfect primary survey while simultaneously checking the patient’s library card. It’s a lot to juggle, but in 2025, it’s non-negotiable for maintaining that coveted verification.
The "Must-Dos" (Without the Bureaucratic Fluff)
Under the 2022 Standards (revised for July 2025), the ACS isn't just suggesting you chat about happy hour—they’re mandating it (American College of Surgeons [ACS], 2025).
The 80% Rule: You must screen at least 80% of admitted trauma patients aged 12 and older for alcohol misuse. If they’re over 12 and have a pulse, they likely need a screening tool (like the AUDIT-C or CAGE) or a blood alcohol content (BAC) test (Optimal Healthcare Advisors, 2025).
The Intervention Deadline: If a patient screens positive, you have to provide a documented brief intervention for at least 80% of them before they head out the door (Optimal Healthcare Advisors, 2025).
The Penalty Box: Failing these metrics doesn't just result in a stern look; it can lead to two Type II deficiencies during your site visit (Optimal Healthcare Advisors, 2025).
A Witty Take on the Protocol
Screening (S): This is where we ask patients about their drinking habits with the same clinical detachment we use to ask about their last tetanus shot. Pro-tip: If they say "I only have two drinks," in trauma math, that usually means four. Screening tools such as AUDIT-C and CAGE are validated and widely recommended for trauma centers (Optimal Healthcare Advisors, 2025; Billings Clinic, 2025).
Brief Intervention (BI): This isn't a lecture; it's a motivational conversation. It’s the art of convincing someone that maybe—just maybe—their third DUI and this fractured femur are related. Brief interventions are an evidence-based strategy for harm reduction and are endorsed in ACS-aligned clinical guidance (ACS, 2023).
Referral to Treatment (RT): For the patients who need more than a "hey, maybe slow down," you need a solid path to specialty care. Trauma centers must have a mechanism to connect them to specialty care. ACS guidelines emphasize establishing referral pathways and providing structured access to treatment resources (ACS, 2023; SAMHSA, n.d.) In 2025, this often involves a smooth handoff to Social Work or a Behavioral Health team who has much better "soft skills" than a post-night-shift trauma nurse.
The 2025 Reality Check
The ACS 2022 Standards (with the July 2025 Revision) emphasize that while some other requirements have been "relaxed," the push for mental health and substance use screening remain core expectations of Level I and II trauma centers (ACS, 2025; ACS, 2023).
Bottom Line: SBIRT is the ACS’s way of saying "Fix the patient, but also try to fix what brought them here." It’s professional, it’s evidence-based, it’s clinically meaningful, and yes — it’s one more box to click in Epic. But it’s also the only part of our workflow that can prevent the "sequel" trauma (ACS, 2023).
References
American College of Surgeons. (2025). Resources for Optimal Care of the Injured Patient (2022 Standards), July 2025 revision. [facs.org]
American College of Surgeons. (2023). Mental Health Disorders and Substance Use and Misuse in the Trauma Patient: Clinical Guidelines. Guideline Central. [guidelinecentral.com]
Billings Clinic. (2025). Screening, Brief Intervention, and Referral to Treatment (SBIRT) Policy and Procedure TP‑1001. [billingsclinic.com]
Optimal Healthcare Advisors. (2025). 5 Essential steps for trauma centers to meet SBIRT standards. [oha-llc.com]
Substance Abuse and Mental Health Services Administration. (n.d.). Screening, Brief Intervention, and Referral to Treatment (SBIRT). [samhsa.gov]
