Time to ACT: launching an Addiction Care Team (ACT) in an urban safety-net health system

Abstract

Across the USA, morbidity and mortality from substance use are rising as reflected by increases in acute care hospitalisations for substance use complications and substance-related deaths. Patients with substance use disorders (SUD) have long and costly hospitalisations and higher readmission rates compared to those without SUD. Hospitalisation presents an opportunity to diagnose and treat individuals with SUD and connect them to ongoing care. However, SUD care often remains unaddressed by hospital providers due to lack of a systems approach and addiction medicine knowledge, and is compounded by stigma. We present a blueprint to launching an interprofessional inpatient addiction care team embedded in the hospital medicine division of an urban, safety-net integrated health system. We describe key factors for successful implementation including: (1) demonstrating the scope and impact of SUD in our health system via a needs assessment; (2) aligning improvement areas with health system leadership priorities; (3) involving executive leadership to create goal and initiative alignment; and (4) obtaining seed funding for a pilot programme from our Medicaid health plan partner. We also present challenges and lessons learnt.

Keywords: PDSA; healthcare quality improvement; hospital medicine; patient-centred care; quality improvement.

Figure 1

ACT consultation requests, 1 January 2019–31 December 2019. *ACT was consulted for 631 hospitalisations during our first year. We staffed 73% of consults. Reasons consults went unstaffed include consultation question was answered via phone, ACT not yet available to requesting service or patient discharged prior to being seen.