Background: Patients with Substance Use Disorder (SUD) are a nationwide concern. They have significant morbidity, mortality & for several reasons, such as comorbid psychiatric conditions, medication noncompliance, low income or poor access to healthcare services, have an increased risk of hospital readmissions. Processes aimed at reducing readmission rates in this population are important for improving patient outcomes, cost savings and use of healthcare resources. With this realization, coupled with the recent effects of the COVID-19 pandemic & increase in use of telemedicine services, a research project was developed to assess patient outcomes with the use of a telemedicine-delivered consult service.
Methods: An Ishikawa diagram was used to identify gaps in care of patients hospitalized with SUD. An impact/effort grid was used to identify key gaps & the Six Sigma methodology was used to develop a quality improvement project. Interventions included inpatient social work consultations to arrange chemical dependency assessments by Licensed Alcohol and Drug Counselors prior to discharge. The primary data source for our improvement measure outcome was the electronic medical record. Our method of data collection was retrospective chart review and web-based data entry. Chi square testing was performed.
Results: Before the project, there was a mean of 3 LADC referrals per month. Preliminary data shows an increase to a mean of 12 per month after a total of 117 patients were referred. Of 74 completed consultations, preliminary data shows a decrease in 30 day readmission rates from 25.8% in 2019 to 19.39%.
Conclusions: SUDs are maladaptive patterns of substance use leading to clinically severe impairment or distress potentially affecting physical or psychological functioning; personal safety; social relations, roles, and obligations; work; and other areas1 Patients with SUD can be challenging when discussing factors attributing to their increased risk for hospital readmission. A SUD optimization project was developed to address many of these areas. By increasing hospitalized patients’ access to LADCs via virtual consultations for chemical dependency assessments, we were able to decrease 30 day hospital readmission rates from 25.8% to 19.39%. This highlights the significance of processes aimed at this unique population with goals of promoting better patient outcomes as well as cost-savings. It also shows the role telemedicine plays in healthcare delivery. For future work, continued evaluation of this intervention on rates of readmissions, emergency department visits, relapses, successful completion of a chemical dependency program, and patient satisfaction could be done.