By Corey Waller, Better Care Playbook Faculty and Principal at Health Management Associates
I currently do some work as a locum tenens physician in the emergency department, filling in during staff shortages. In this capacity, I get to work in a few different hospital systems around the country. No matter which one I go to, I can count on the fundamental aspects of basic cardiac care to be delineated no matter where I am.
Here’s the pathway: If a patient shows up to their primary care doctor and complains about chest pain, the provider will assess her with an EKG to determine if she’s having a serious heart attack, call 911, and rapidly transport the patient to the nearest emergency department. The ED then evaluates the patient’s acuity and takes appropriate action: referring to outpatient care, admitting for observation and testing, sending for a heart catheterization, or admitting to a cardiac care unit.
In some places, definitive care requires a helicopter to get them to a facility, and in others, they can do everything inside their own hospital. However, it doesn’t seem to matter which hospital I’m working in. They all know what levels of care are available to their patients who show up to the door complaining of chest pain.
At any given time in a level I Trauma Ctr. in the United States it is estimated that up to 60 percent of patients meet the criteria for a substance use disorder. This is a pretty frightening statistic, given that the vast majority of inpatient health systems do not routinely screen for any addiction other than tobacco use disorder. This is also interesting given the density of social work and care management staff that are allocated to the hospital-based settings as compared to the outpatient treatment world. However, it is relatively common knowledge among those that treat patients in a hospital setting that addiction-related issues are the number-one driver of extended length of stay, 30-day readmissions, and job-related dissatisfaction and burnout. We should be treating addiction as a human resources problem as much as a health care ecosystem problem.
In my experience, the vast majority of these shortcomings are due to a lack of cohesive systems built within the hospital setting to detect and treat these conditions, a workforce with the appropriate knowledge base to initiate and stabilize treatment, and probably most importantly, a significant frustration and stigma toward patients with substance use disorders. To read more about the barriers, please see the last blog post I wrote on addiction.
Approximately 30 years ago, the American Society of Addiction Medicine started developing the patient placement criteria that allowed for an evaluation of the patient through a series of questions that allowed for both an accurate and precise determination of what type of care they should receive. These are referred to as the ASAM levels of care and are accepted as the national standard by all payers and government entities.
This is what we need to do for patients who show up to our door with a diagnosis of addiction. We need to offer varying levels of treatment depending on the level of severity. To that end, the Better Care Playbook has just published a new practical Play on treating addiction in the inpatient setting.
It seems easy right? We should be able to flip the switch and get this done within the next couple weeks. To those that don’t think we can, I will remind you that it only took about two weeks for every hospital in the country to develop screening and treatment and purchase full personal protective equipment for Ebola. Ebola was responsible for the death of one person in the United States, and opioid use disorder is responsible for the deaths of more than 50,000 people per year from overdose, I think we should feel obligated to develop this pathway with equal intensity.
What do you think is holding us back? If you’ve developed a treatment pathway, what tips would you share with other health systems? Leave a comment below.