Efficacy of a Substance Abuse Program in a Regional Emergency Department

The BCMS Pat Sharma President’s Scholarship

Efficacy of a Substance Abuse Program in a Regional Emergency Department

by Kirill Popovich, University of North Carolina at Chapel Hill; Amanda Hill, Alvernia University; Christian Brito, Millersville University; Erica Tait, Alvernia University; Joaquim Diego Santos, Pennsylvania State University; Alexis Schoener, Pennsylvania State University; McKenna Brower, Syracuse University; Adam Sigal, MD; Traci S. Deaner, MSN, RN; Megan Reed; Monisha Bindra, DO; Charles Barbera, MD

INTRODUCTION: Drug and alcohol abuse can be considered a widespread epidemic in the US. In an attempt to not only treat patients with acute substance intoxication, but also to cure their chronic use, the Reading Tower Health Hospital Emergency Department (ED) implemented a handoff program named the “Warm Handoff” (WHO). This program allows physicians to offer care outside of the ED by “handing off” a patient diagnosed with substance abuse to an appropriate acute detoxification/ rehabilitation facility. This study attempts to determine the efficacy and utilization of WHO, as well as provide data that will be used to modify and improve the program’s implementation.

METHODS: The study was conducted in a retrospective fashion. Patient records were retrieved based on an HIM code screening which selected any patient that presented to the ED with acute intoxication or an issue in which substance abuse played a major role. The patients were deidentified using the REDCap software database, and a form was filled out for every patient based on their history. It was important to determine whether WHO was offered/ not offered, whether the patient accepted/declined, and whether they presented to the ED with substance abuse at a later period in time, usually in the span of two years. Different statistical methods were performed to determine the outcome of the multiple related variables. RESULTS: The working sample size consisted of 2027 subjects. Of those, only 888 (43.8%) had a WHO consult offered, and 544 (26.8%) accepted the WHO consult. Of those accepting a WHO consult, only 421 (20.8%) accepted treatment, 305 (15.0%) subjects were referred to inpatient treatment, and 116 (5.7%) were referred to outpatient treatment. Of the 544 subjects who accepted treatment, 18 subjects (3.3%) came back due to substance abuse in 72 hours, 36 subjects (6.6%) came back between 72 hours and 30 days, 28 subjects (5.15%) came back between 30 and 60 days, 147 subjects (27.0%) came back between 60 days and 1 year, and 130 subjects (23.9%) came back between 1 year and 2 years.

CONCLUSION: Based on the data, the WHO program is only offered 44% of the time. It is accepted with an even lower rate and even fewer people accept and attend treatment. Providers cannot force a patient to attend treatment, but the rate of WHO offerings must increase for a greater efficacy. In the early phases of the program, a patient could refuse a WHO consult. The process was later changed to automatically order a consult without patient approval to increase compliance. Therefore, out of the patients to whom a consult was offered, only 61% accepted. Some of the limitations of the study can be attributed to the lack of data in the case that a patient did not return to the ED for a substance abuse issue. Hence, it is impossible to know what exactly happened to the patient and whether they fully recovered or are currently under the influence of substance abuse.