Purpose: To describe the impact of hospitalist and addiction medicine co-management within a single inpatient Addiction Recovery Program (ARP) Unit.
Description: Data was collected from a single level 4 inpatient ARP unit within an academic medical center. This unit transitioned from an independently functioning 14 bed unit managed solely by Addiction medicine staff, into an 8 bed program with Hospitalist and Addiction medicine co-management. This transition was prompted by a reduced demand for level 4 inpatient addiction recovery management, and increased acuity among patients who continued to meet this requirement (largely attributable to the successful outpatient use of Suboxone).
Pre- and post-transition measures included: average daily census, number of admissions, patients meeting criteria for a level 4 admission, AMA discharges, patient safety events, and ICU transfers. In addition to these objective measures, subjective measures including patient satisfaction and provider self-perception of competency were evaluated in 2016 after a sustained period of integration.
|
|
Pre-transition (dates: 6/1/12 -12/31/12) |
Post-transition (dates: 5/1/13-10/31/13) |
|
Total admissions to inpatient ARP beds |
414 (306 level 4, 74%) |
352 (352 level 4) |
|
Average length of stay (in days) |
3.7 |
3.7 |
|
Patient Safety Events* (rate per 100 patient days) |
44 (2.87) |
12 (0.9) |
|
Transfer to the ICU (Rate per 100 patient days) |
5 (0.32) |
3 (0.23) |
*Issues with: airway management, IV or medication safety, diagnostic tests or rapid response team activation
Despite increasing patient acuity (all patients met criteria for level 4 management post-transition), length of stay has remained stable at 3.7 days, while the frequency of ICU transfers and patient safety events has improved.
Subjective data included patient surveys and interviews with attending hospitalist staff. A total of 59 (response rate 13%) voluntary anonymous patient surveys were returned over a 9 month period (1/1/16 – 9/30/16). Responding patients consistently gave very high ratings of the skill of their physician (98.3% good or very good), how well the unit staff worked together to care for them (96.6% good or very good), and their overall rating of the unit (98.3% good or very good). Qualitative interviews with involved hospitalists revealed: increased self-assessed competency with addiction medicine; improved understanding of the indications and use of naltrexone, acamprosate and Suboxone; and higher levels of empathy for patients with addiction related health problems.
Conclusions: Co-management between hospitalist and Addiction medicine specialists can offer improved patient safety, excellent patient satisfaction, and improved hospitalist competency with addiction medicine. Enhancing hospitalist competency and patient care are important aspects of physician response to our nation’s ongoing struggle with substance abuse disorders and their health consequences.