Community-based Substance Abuse Coalition Creates Mandate for Improvement of Substance Abuse Care for Hospitalized Patients - PowerPoint PPT Presentation

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Community-based Substance Abuse Coalition Creates Mandate for Improvement of Substance Abuse Care for Hospitalized Patients

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Community-based Substance Abuse Coalition Creates Mandate for Improvement of Substance Abuse Care for Hospitalized Patients Joan Quinlan, MPA, Susan Krupnick, MSN ... – PowerPoint PPT presentation

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Title: Community-based Substance Abuse Coalition Creates Mandate for Improvement of Substance Abuse Care for Hospitalized Patients


1
Community-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
  1. Develop (and educate physicians and nurses about)
    a new inpatient pathway for the detection and
    treatment of alcohol withdrawal.
  2. Create a new clinical nurse specialist (CNS)
    position in the ED.
  3. 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.
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