A Model to Improve Care and Enhance the Physician-Patient Relationship for Hospitalized Patients With Opioid Use Disorder.

Problem: Opioid-related morbidity and mortality continues to accelerate, with increasing acute care events for opioid-related causes. Most patients do not receive evidence-based treatment for opioid use disorder (OUD) during acute hospitalizations despite this being an invaluable moment to initiate substance use treatment. Inpatient addiction consult services can bridge this gap and improve patient engagement and outcomes, but varying models and approaches are needed to match institutional resources.

Approach: To improve care for hospitalized patients with OUD, a work group was formed at the University of Chicago Medical Center in October 2019. An OUD consult service, run by generalists, was created as part of a series of process improvement interventions. Important collaborations with pharmacy, informatics, nursing, physicians, and community partners have occurred over the last 3 years.

Outcomes: The OUD consult service completes 40-60 new inpatient consults monthly. Between August 2019 and February 2022, the service completed 867 consults from across the institution. Most consult patients were started on medications for opioid use disorder (MOUD), and many received MOUD and naloxone at discharge. Patients who were treated by our consult service experienced lower 30-day and 90-day readmission rates compared with patients who did not receive a consult. Length of stay for patients receiving a consult was not increased.

Next Steps: Adaptable models of hospital-based addiction care are needed to improve care for hospitalized patients with OUD. Continued work to reach a higher percentage of hospitalized patients with OUD and to improve linkage to care with community collaborators are important steps to strengthen the care received by individuals with OUD in all clinical departments.