Improving Psychiatric Follow Up Attendance Post Hospitalization For People With Comorbid Substance Use Disorders

Abstract

Problem: Patients with comorbid psychiatric disorders (PD) and substance use disorders (SUD) have a 27-35% likelihood of attending scheduled follow up visits per site data from 2021. Patients often require community follow-up to reduce the length of disability. Purpose: The objective of this quality improvement (QI) project is to implement and integrate peer recovery coaches (PRCs) into an inpatient psychiatric setting. The long-term plan for the institution is to assess attendance rates of follow-up appointments for patients with comorbid PD and SUD who received PRC interventions. Studies indicated PRC use improved outpatient treatment engagement significantly. PRCs demonstrate utility in engaging with patients, connecting them to treatment in the community, and balancing social determinants of health. Methods: This QI project required structure changes including: (1) training inpatient psychiatric staff about PRCs using a developed educational video, (2) orienting PRCs to the setting by unit management, and (3) coding PRC documentation into the EHR by the institution’s informatics team. Data is collected from the PRC regarding the amount of patients with comorbid PD and SUD referred, seen, and refused during implementation period of August 2022-December 2022. The evidence supports increased appointment attendance with PRC intervention and this data will be tracked on a long-term basis. Results: The number of referrals to the PRC per week ranges from 2-7 patients. For eleven out of the fourteen weeks, all of the patients who were referred were seen by the PRC within 1 week of referral. The PRC missed the 1 week timeframe during weeks of low staff and a personal emergency. He was able to see all but one of the patients the following week. One out of fifty-two patients refused the PRC encounter during the implementation period. Conclusions: The system of referrals appears to be intact. The low refusal rate alludes to patients expressing an interest in working with a peer. Positive findings speak to the possibility of benefits associated with PRCs and could potentially be cost saving by bridging gaps to outpatient care. This intervention could potentially be used on different units and hospitals with similar social determinants of health and substance use epidemics.