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An Inpatient Treatment and Discharge Planning Protocol for Alcohol Dependence: Efficacy in Reducing 30-Day Readmissions and Emergency Department Visits

  • Innovation and Improvement: Innovations in Medical Education
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ABSTRACT

BACKGROUND

Alcohol dependence results in multiple hospital readmissions, but no discharge planning protocol has been studied to improve outcomes. The inpatient setting is a frequently missed opportunity to discuss treatment of alcohol dependence and initiate medication-assisted treatment, which is effective yet rarely utilized.

AIM

Our aim was to implement and evaluate a discharge planning protocol for patients admitted with alcohol dependence.

SETTING

The study took place at the San Francisco General Hospital (SFGH), a university-affiliated, large urban county hospital.

PARTICIPANTS

Learner participants included Internal Medicine residents at the University of California, San Francisco (UCSF) who staff the teaching service at SFGH. Patient participants included inpatients with alcohol dependence admitted to the Internal Medicine teaching service.

PROGRAM DESCRIPTION

We developed and implemented a discharge planning protocol for patients admitted with alcohol dependence that included eligibility assessment and initiation of medication-assisted treatment.

PROGRAM EVALUATION

Rates of medication-assisted treatment increased from 0 % to 64 % (p value < 0.001). All-cause 30-day readmission rates to SFGH decreased from 23.4 % to 8.2 % (p value = 0.042). All-cause emergency department visits to SFGH within 30 days of discharge decreased from 18.8 % to 6.1 % (p value = 0.056).

DISCUSSION

Through implementation of a discharge planning protocol by Internal Medicine residents for patients admitted with alcohol dependence, there was a statistically significant increase in medication-assisted treatment and a statistically significant decrease in both 30-day readmission rates and emergency department visits.

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Acknowledgements

We would like to thank the University of California, San Francisco Internal Medicine residents for their participation. We would also like to thank Jenee Bryant, MSW, Katie Luttrell, MSW, Amy Logan, Pharm.D., David Hersh, MD, Paula Lum, MD, and Richard Brooks, MD for their support throughout this project.

Funders

None.

Prior Presentations

We presented an earlier version of the manuscript as a poster for the University of California, San Francisco Quality and Safety Symposium on 29 May 2012. This abstract was also presented for the Association of Medical Education and Research in Substance Abuse (AMERSA) conference on 3 November 2012.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Author information

Authors and Affiliations

  1. University of California, San Francisco, San Francisco, CA, USA

    Jennie Wei MD, MPH, Triveni Defries MD, MPH, Mia Lozada MD, Natalie Young MD, William Huen MD, MS, MPH & Jacqueline Tulsky MD

  2. University of California, San Francisco, 1506 Fairways Circle, Gallup, NM, 87301, USA

    Jennie Wei MD, MPH

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  1. Jennie Wei MD, MPH
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  2. Triveni Defries MD, MPH
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Corresponding author

Correspondence to Jennie Wei MD, MPH.

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Wei, J., Defries, T., Lozada, M. et al. An Inpatient Treatment and Discharge Planning Protocol for Alcohol Dependence: Efficacy in Reducing 30-Day Readmissions and Emergency Department Visits. J GEN INTERN MED 30, 365–370 (2015). https://doi.org/10.1007/s11606-014-2968-9

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  • DOI: https://doi.org/10.1007/s11606-014-2968-9

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