Building capacity to address opioid use disorder (OUD) in inpatient acute care settings can appear a complex endeavor, but providing access to Food and Drug Administration-approved medications for OUD (MOUD) is both feasible and rewarding. At UChicago Medicine, we identified an opportunity to enhance the inpatient care of patients affected by OUD. By leveraging general medicine expertise and building collaboration between the hospital campus and local community-based treatment providers, we launched an OUD consult service in January 2020 that has since boosted the provision of evidence-based care for patients with OUD resulting, in a reduction in both hospital 30-day readmissions and discharges against medical advice.
The cornerstone of building this program was having leadership support to get the right stakeholders involved. In our case, an interdisciplinary team was formed, including physicians, pharmacists, social workers, quality, nurses, and informatics and IT. This group utilized agile project management techniques to implement rapidly an inpatient consult service focused on initiation of MOUD and post-discharge referral network for continuity of OUD care.
There were several key milestones in this process. At the start physician champions with the appropriate Drug Enforcement Administration X-waiver training were identified to staff for the consult service. The workgroup also established new clinical protocols and procedures; adjusted the hospital formulary to include the necessary medication formulations; and identified an initial network of community referral partners. With these critical pieces in place, the consult service began offering inpatient initiation of MOUD while optimizing workflows over time.
To manage the rapid optimization of inpatient OUD care, the team started meeting on a bi-weekly basis and set a goal to deliver at least one implemented enhancement to the consult service every two weeks. These enhancements included:
- establishing additional partnerships and iteratively refining the referral processes to link patients with community based treatment after discharge;
- developing patient education documents;
- developing a nursing education program on OUD, medications for OUD and opioid withdrawal;
- adding consult ordering and documentation workflows for the OUD service;
- adding clinical treatment algorithms to the electronic medical records; and
- increasing the pool of waiver-trained providers by sponsoring the necessary training.
Leveraging external expertise was also crucial. UChicago participated in the AHA Opioid Stewardship collaborative, a group whose toolkit provides guidance and information to hospitals and health systems on how they can partner with patients, clinicians and communities to address the opioid epidemic. By leveraging these external tools our team was able to focus on local implementation of established successful practices, rather than design our intervention from the ground up. The AHA also continues to provide support for hospitals and health systems with OUD and stigma resources, including a new poster in its People Matter, Words Matter series.
With now over 300 consults completed, the UChicago Medicine OUD consult service has proven a valuable resource for patients and clinicians. Improving access to evidence-based OUD treatment options has been an iterative process, but is approachable and beneficial to both patient experience and outcomes.
George Weyer, M.D., is an internal medicine and pediatrics physician, assistance professor of medicine and the executive medical director of accountable care at UChicago Medicine.
Opinions expressed by the authors do not necessarily reflect the policy of the AHA.