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

Joan Quinlan, MPA, Susan Krupnick, MSN, APRN, BC, CARN &Theodore A. Stern, MD

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.

Introduction 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.

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.

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.

*This work was supported by the MGH Community Benefits Program. Please email Joan Quinlan at jquinlan1@partners.org with any questions or comments.

Method

Recommendations

Conclusions

Future Directions 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

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.

Results

MGH Community Benefit Program

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