More than MAT: lesser-known benefits of an inpatient addiction consult service.

Abstract

Substance use disorders (SUDs) are ubiquitous among medical, surgical, and psychiatric admissions in hospitals across the United States, and many staff are not specifically trained to provide trauma-informed, evidence-based SUD care. To address this need, some hospitals – particularly in urban, academic institutions – have implemented an inpatient addiction consult service (ACS). These specialized, multidisciplinary teams can provide timely pharmacologic, psychotherapeutic, and carelinkage interventions during the ‘reachable’ moment of hospitalization [1]. In the August 2022 edition of the New England Journal of Medicine, authors Englander & Davis published a thorough and mobilizing call for hospitals and policymakers to establish a new standard of care for patients with SUDs, including via support for inpatient ACS teams [2]. Patient care outcomes such as addiction severity [3], readmission risk [4], treatment follow-up [5], evidence-based medication initiation [6], and inpatient antibiotic treatment completion [6] have been shown to improve with ACS involvement – in no small part related to medications for addiction treatment (MAT). But there are also many benefits to an ACS that extend beyond patient care outcomes. In this article, we highlight our first-hand experience at a safety-net hospital that expanded its ACS to great effect, particularly in terms of 1) staff recruitment and retention, 2) widespread trainee education, 3) quality improvement, and 4) pragmatic clinical research. Direct quotations from key informants are included (with explicit permission when possible) as well as results from a staff survey regarding perceptions of the ACS.