Caregivers at Boston Medical Center (BMC) have released a study outlining how the hospital’s Addiction Consult Service (ACS) may be making a significant dent in the problem of inpatients with substance use disorder (SUD) relapsing into addiction – and being readmitted – shortly after discharge.

Numerous studies have shown that many inpatients (15% by one Massachusetts study) have an active SUD, and that they’re likely to be readmitted within 30 days of discharge. But treating a patient for substance use disorder in addition to whatever other forms of treatment the hospital is providing often does not occur.

“Barriers to inpatient initiation of medications for [opioid use disorder] include the limited availability of outpatient providers and programs, lack of insurance coverage, and federal privacy regulations that make coordinating and integrating medical and addiction care difficult,” BMC researchers wrote in the Journal of Substance Use Treatment.

To address the problem, BMC created its Addiction Consult Service in July 2015. The physician-RN ACS team meets with the patient, provides brief bedside counseling, initiates addiction-treatment medications, and formulates discharge planning.

“Discharge work for the ACS included collaborating with the primary hospital medical team, social work, and hospital case management, as well as coordination with and linkage to post-discharge addiction providers,” according to the study. “The ACS regularly collaborated with social work within the hospital and held weekly joint rounds with the Psychiatry Consult and Liaison service.”

Two BMC outpatient clinics and three local methadone clinics were the main post-discharge linkages.

BMC reports that over the first 26 weeks, the ASC received 367 referrals resulting in 337 consults. (Some patients left against medical advice, refused to be seen, etc.)

“Like heart disease can cause a heart attack or a stroke, addiction causes many acute injuries requiring immediate attention, but we can’t simply treat that issue without delving deeper to address the root cause,” said Alex Walley, MD, MSc, a general internist at BMC’s Grayken Center for Addiction who also oversees the addiction medicine fellowship. “Our goal is to engage willing patients in treatment and work with them on a plan that will keep them healthy and safe now and in the future.”

MHA’s V.P. of Clinical Affairs Pat Noga, RN, FAAN, who is involved in the association’s work on opioids, said BMC’s ACS work is well-known within the caregiving community and provides a template for work by other hospitals or state efforts going forward.

Click on the link to read the full study: Addiction consultation services – Linking hospitalized patients to outpatient addiction treatment.

And click here to read about the efforts of MHA’s Substance Use Disorder Prevention and Treatment Task Force that has developed guidelines for hospital to use in addressing the opioid crisis.

In 2013, during a period of significant institutional growth, Beth Israel Deaconess Hospital–Needham (BID–Needham) began an organization-wide effort to enhance its commitment to patient safety, employee engagement, and patient and staff satisfaction.

As a result if its efforts, BID-Needham’s scores on the AHRQ Culture of Safety Survey rose to the 98th percentile rank within one year of implementation and have been sustained since then, with the hospital’s 2016 survey scores remaining in the 96th percentile. This effort was led by the hospital’s executive leadership team with the engagement and full support of the board of directors.

For its efforts, BID–Needham was the winning entry in the “Enhancing Culture and Leadership” category of the 2017 MHA Compass Awards. Entries in each of the six Compass Award categories were voted on by non-Massachusetts judges from across the U.S., who assessed the entries “blind” – meaning there were no details to identify the hospital competing.

Since 2010, BID–Needham has conducted, through an approved vendor, the Culture of Safety survey. In 2013, the hospital set out to evaluate the hospital’s culture and the physicians’ and employees’ feelings about workplace satisfaction. Over the next year, a comprehensive evaluation of existing processes, procedures and behaviors was conducted throughout the hospital with a message to all staff and physicians of a renewed commitment to patient safety and staff engagement to find solutions.

Following the broad assessment, a hospital initiative entitled “Drive” was developed in partnership with leadership and direct line staff members. Drive focused on leadership development and accountability, employee engagement, and improving the patient experience. As part of the cultural transformation process, goals included increasing transparency and consistency of communication, creating a just and learning culture and encouraging confidence in the safety event reporting system and follow-up. Multi-disciplinary workgroups were implemented and included leadership and direct care givers. Commitment to patient safety was always central to the goals.

Since implementing the initiative BID–Needham has seen sustainment of staff confidence in the safety culture as well as improved job satisfaction. Additionally, because of the improved transparency of communication and teamwork, the hospital is able to respond more quickly and be proactive when it identifies potential problems via monthly quality surveillance (e.g., fall prevention, skin integrity, and medication events). Patient satisfaction, through HCAHPS scores, has seen consistent improvement.

Asked in the Compass Award application to list the three lessons learned, BID–Needham wrote: 1) Leadership and Board support are essential for driving transformational changes; 2) Staff engagement and partnership with leadership is essential to driving sustainable change; and 3) Transformational change occurs with commitment and organizational purpose.