1043 Standardized patient-care protocol for drug-use associated illness in pregnancy and postpartum decreases inpatient adverse events

Abstract

Due to an increase in drug-use associated hospital admissions and adverse events (AE) among those patients, their visitors and staff, our institution offers a Drug-Use Associated Illness Protocol (DUAIP). DUAIP limits visitation and off-floor privileges, is driven by patient choice, with goal of integration into addiction facility after discharge. We hypothesized that pregnant/postpartum women admitted for drug-use related illness selecting DUAIP would have fewer AE, with secondary aims to assess utilization of psychiatric care/addiction treatment. A retrospective chart review was completed identifying women admitted for drug-use associated illness in pregnancy or postpartum between January 2017 and August 2020. Women were identified by ICD 10 codes, included for ongoing illicit drug-use, and excluded for delivery admission, prescribed opiates, or THC use only. Basic demographic data, frequency of AE, and disposition were reviewed (individually and as composite outcome) and compared by use of DUAIP. Data were analyzed using Chi-square and student T test where appropriate. 1088 patient encounters were identified: 108 meeting inclusion criteria, 24 DUAIP and 83 controls. Comparison of demographic data revealed similar populations between the 2 groups; majority Caucasian, had Medicaid, and positive Hepatitis C status. AEs, disposition, and outcomes are presented in the Table. Use of DUAIP was associated with higher rates of leaving against medical advice (p=0.003), but longer overall length of stay. Significantly fewer composite AEs were identified in the DUAIP compared to non-protocol (p=0.0007). Higher uptake of psychiatric and drug rehabilitation services were seen in the DUAIP group but did not reach statistical significance. DUAIP use was associated with higher rates of leaving AMA, but fewer composite AEs with a trend in greater utilization of mental health and long-term rehabilitation care. Further studies are planned to assess implications of DUAIP use and clinical practices that increase entry into drug rehabilitation programs.