From the 2019 HVPAA National Conference
Dr. Rohan Singh (Long Island Community Hospital), Dr. Wehbeh Wehbeh (Long Island Community Hospital), Ms. Maryann Demeo (Long Island Community Hospital), Dr. Ravi Gupta (Long Island Community Hospital)
Healthcare professionals across the country are struggling to confront the opioid epidemic. Many providers have misconceptions about opiate addiction and often do not have the tools to properly identify and treat these patients. From 2009-2014, there was a 73% increase in ED visits for opiate related issues. In 2015, the White House Council of Economic Advisors estimated that the opioid epidemic cost the economy approximately $504 Billion. In 2019, the National Safety Council reported that Opioid Overdose rates exceeded deaths from motor vehicle accidents.
To address the opioid crisis in our community, our institution formed a multi-disciplinary team to study our patient data and develop new policies to improve the identification and management of patients with addiction disorders and to reduce the stigma of addiction by implementing evidence-based practices.
As a result, harm-reduction strategies were implemented; such as increased substance abuse screening in the ED. In this we have hired full-time SBIRT social workers (Screening, Brief Intervention, and Referral to Treatment) to assist with appropriate aftercare referrals. We have also implemented staff sensitivity training on the stigma of addiction. We have made information about proper and timely outpatient follow-up more easily and readily available to those willing and in need of further care.
We have also now begun the process of providing psycho-education and additional training on how to properly and expediently evaluate, monitor and treat these patients. In this we have increased inpatient CINA protocol use by educating Physicians and Nursing Staff about proper management and improving anticipation of withdrawal symptoms by using the CINA score. This should increase quality of care that the patients receive during their stay and will minimize withdrawal symptoms as they can be caught earlier on.
As a result of our implementations, brief interventions with patient counseling done in the ED increased by 1075%, in addition to increased utilization of Substance Abuse Mental Health Services to assist patients with appropriate aftercare referrals. We have also implemented harm-reduction strategies such as distribution of Narcan kits for home use. This was begun by first educating physicians on Narcan distribution and by increasing overdose rescue-kits distributed from ED. We’re also utilizing SBIRT tracking of the distributed Narcan kits for these patients at risk. Narcan Distribution had a monthly increase of over 315% since the initiatives start. The committee also developed a standardized order set for narcotic withdrawal based on best-practices from national societies.
Using a multi-disciplinary approach, our team has already had a dramatic effect in improving our patient care. These changes can and should be easily applied to other healthcare facilities. We’re excited to see what future changes will occur with continued effort and analysis.
Clinical implications of this initiative can greatly benefit quality of care. We’re creating awareness within the hospital and community about this disease to bring our patients higher quality care and to start changing the stigma surrounding substance abuse. This enables those seeking care to do so more easily and expediently as patients have more accurate information about how to seek treatment.