The substance use intervention team: A hospital-based intervention and outpatient clinic to improve care for patients with substance use disorders.

Abstract

In response to the opioid crisis, public health advocates urge hospitals to perform substance use disorder (SUD) screening, brief intervention, discharge planning with referral to treatment, and naloxone education. Universal screening makes specialized treatment available to all patients and decreases stigma around SUDs, allowing patients and providers to address SUDs during their hospitalization. Additionally, hospital and emergency department-initiated medications to treat SUD improve patient engagement with treatment and decrease opioid use, and use of medications for opioid use disorder after nonfatal overdoses decreases mortality. A substance use intervention team (SUIT) service was established to offer universal screening and consultation by an interdisciplinary team at our urban academic medical center. The SUIT program provides inpatient consultation services as well as medical and behavioral clinic visits to transition patients to long-term treatment and is comprised of physicians, nurse practitioners, a clinical pharmacist, social workers, and a nurse. Successes attributed to enhanced medication use as a function of having a designated pharmacist as an integral member of the team are highlighted. Our medical center initiated screening efforts in tandem with its interdisciplinary team and clinic. The team attempts to start appropriately selected patients with SUD on medications for SUD while hospitalized. From January through December 2018, 87.2% of patients admitted to the hospital received initial SUD screening. Of the patients who screened positive, 1,400 received a brief intervention by a unit social worker; the SUIT service was consulted on 880 patients, and multiple medications for SUD were started during inpatient care. A screening, brief intervention, and referral to treatment service was successfully implemented in our hospital, with the SUIT program in place to provide interdisciplinary addiction care and initiate medications for SUD in appropriate patients.