Agreed with the informal questioning. In my state there is a proposal this legislative session to have substance abuse counselors available 24/7 in the ER. The news ran the story in the section on far fetched legislative proposals citing the main reason that it is unlikely to pass is that even if we did have someone in the ER to counsel people the are not enough outpatient resources to refer them to. The same is true with mental health the Mental Health screeners in the ER essentially make sure they are not suicidal/homicidal and send people back out to the streets that are not suicidal/homicidal, telling them to follow up outpatient. Again there are not many outpatient resources. Even if there were many people who have experienced trauma or are substance abusers have had the executive function portion of their brain that helps them organize themselves compromised and will likely never follow up.
Health systems many times don't want things documented that might expose them to liability. So for example if a person comes to the ER, we document ACE but they have no immediate need for hospitalization we discharge them and they cause harm to self or others then it exposes them to risk. For that reason it is less likely that Hospital systems will implement it.
If they did implement it they would put it on the standardized form in the EMR that initial screeners fill out for discharge planning. They create alot of these templates for Physical Therapy, Occupational therapy etc.
I do appreciate the efforts of all to bring the ACE questionaire into the vernacular.
I do still document it informally, I have not received negative feedback at this point.