Title: Community-based Substance Abuse Coalition Creates Mandate for Improvement of Substance Abuse Care for Hospitalized Patients
1Community-based Substance Abuse Coalition Creates
Mandate for Improvement of Substance Abuse Care
for Hospitalized Patients Joan Quinlan, MPA,
Susan Krupnick, MSN, APRN, BC, CARN Theodore A.
Stern, MD
Introduction
Method
Results
- Inpatient pathway shorter LOS, and significantly
less delirium than was evident for a similar
cohort of patients seen before initiation of the
pathway (3). - Bed reservation program significantly fewer
patients with alcohol abuse as the only diagnosis
upon admission to the hospital (4) and more
placed in community-based detox. - Evaluation of the CNS position in the ED is still
underway.
The mission of the Massachusetts General Hospital
(MGH) Community Benefit Program (CBP) is to
collaborate with underserved communities to
improve health. Revere, MA, an MGH health center
site, identified youth substance use as a major
public health issue. Therefore, Revere CARES, a
community-based youth substance abuse coalition
supported by the MGH CBP, was formed in 1997.
Simultaneously, concerned clinicians at the MGH
reported that alcohol- dependent patients in the
emergency department (ED) and on inpatient floors
were under-recognized and under-treated. Poor
outcomes including onset of delirium tremens and
long lengths of stay (LOS) were all too common.
Commitment to Care It became apparent that MGH
needed to do more than provide primary prevention
at the community level. To maintain credibility,
MGH also needed to improve care within the
hospital.
- The director of the CBP convened an
interdisciplinary group subsequently known as
the Substance Abuse (SA) Working Group
including psychiatry, addictions services, the
ED, internal medicine, nursing, and social
services. - Issues identified 1) insufficient identification
and treatment of acute alcohol withdrawal in the
ED and - on the inpatient floors 2) inadequate
coordination and communication between the ED and
the inpatient floors and 3) inadequate
relationships with community-based treatment
providers (e.g. detox units). - Data The group agreed to obtain data on LOS for
selected patients with alcohol-related diagnoses.
These studies confirmed anecdotes from the ED
(1) and inpatient floors (2). - Results presented to Senior management
committee three recommendations approved.
Conclusions
- Revere CARES (a community-based coalition
initiated - and supported by MGH) served as a catalyst to
improve - care of patients with alcohol-related illness
within the hospital. - Because of Revere CARES, the director of the CBP
- was given a mandate to convene multiple
departments - and disciplines to address barriers to care
within the MGH. - For the first time, hospital leadership
recognized that the problem of managing substance
abuse was an important clinical issue.
Recommendations
Future Directions
- Develop (and educate physicians and nurses about)
a new inpatient pathway for the detection and
treatment of alcohol withdrawal. - Create a new clinical nurse specialist (CNS)
position in the ED. - Pilot a bed reservation program for uninsured
ED patients with a community-based detox
provider.
- We need to continue collaborative efforts to
improve care further. - Teaching about and implementation of the pathway
is still needed throughout the hospital.
References
(1) Benzer and Mian, unpublished study, 2001 (2)
Blais, M., et al., unpublished study, 2003 (3)
Repper-Delisi, et al. Poster presented at the
Association of Psychiatry and Medicine, New
Orleans, May 9, 2005 (4) Phull, T, Partners
HealthCare Community Benefit Program, TSI MGH
billing database
This work was supported by the MGH Community
Benefits Program. Please email Joan Quinlan at
jquinlan1_at_partners.org with any questions or
comments.