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Journal of General Internal Medicine
Published in: Journal of General Internal Medicine 3/2015

01-03-2015 | Innovation and Improvement: Innovations in Medical Education

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

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

Published in: Journal of General Internal Medicine | Issue 3/2015

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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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Metadata
Title
An Inpatient Treatment and Discharge Planning Protocol for Alcohol Dependence: Efficacy in Reducing 30-Day Readmissions and Emergency Department Visits
Authors
Jennie Wei, MD, MPH
Triveni Defries, MD, MPH
Mia Lozada, MD
Natalie Young, MD
William Huen, MD, MS, MPH
Jacqueline Tulsky, MD
Publication date
01-03-2015
Publisher
Springer US
Published in
Journal of General Internal Medicine / Issue 3/2015
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-014-2968-9

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