1November 4, 2014

Substance Use Disorders Consultation Service (SUDS): Integrating Addiction Services in an Acute Medical Setting

Anika Alvanzo, MD, MS

The Maryland Addictions Directors Council (MADC)

2014 Mid-Atlantic Behavioral Health Conference

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Rationale for SUD Consultation Specialty Services

• Hospitalization may be “teachable moment” • Brief interventions demonstrate reduction in

alcohol consumption and death rates• Provider factors

– under diagnose – under treat– lack confidence in treating

McQueen, et al., 2011Murphy, et al., 2009Moore, et al., 1989

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Historical Perspective

Intervention Services: 1970’s – ~2000

First Step Day Hospital: 1997 – 2010

SUDS: 2010 – present

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Mission

The Mission of the Johns Hopkins Hospital Substance Use Disorders Consultation Service (SUDS) is to improve the health and quality of life of patients with substance addiction by providing non-judgmental, comprehensive, and patient-centered care and education. The SUDS performs brief behavioral interventions and counseling to patients, facilitates linkage to hospital and community-based alcohol and drug treatment programs, provides guidance on the clinical management of substance withdrawal syndromes, and educates patients, families, healthcare professionals and the community to prevent, identify, and treat persons living with addiction.

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SUDS Team

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Who We Are

• Medical Director– Anika Alvanzo, MD, MS

• Nurse– Patricia Burgee, RN, MSN, MBA

• Senior Addictions Therapist– Diane Moses, MSW, M.Ed, LCAD-C

• Interventionist– vacant

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What We Do

• Services– Brief Interventions

• Motivational Interviewing

– Linkage to Treatment Programs– Medical Management of Withdrawal – Pain Management in Patients with Opioid

Use Disorders– Buprenorphine Bridging– Patient and Family Education– Healthcare Professional Education

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Accomplishments

• Electronic Documentation– Qualified Service Organization Agreement (QSOA)

• Relationship Building– Program Visits

• Clinical Database• Improved Clinical Care

– Opioid and alcohol withdrawal protocols

• Customer Survey– 14-item survey using a 5-pt Likert scale (3.1 – 4.8)

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Challenges

• Staffing– Referrals ↑ ~ 30%– 23% not seen (January – March 2014)– Vacation Coverage– No Medical Management Tues/Friday

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Referral Volume: FY11 – FY14

July

Augus

t

Septe

mbe

r

Octob

er

Novem

ber

Decem

ber

Janu

ary

Febru

ary

Mar

chApr

ilM

ayJu

ne0

20

40

60

80

100

120

140

160

180

FY 2011 (893)

FY 2012 (1430)

FY2013 (1457)

FY2014 (1876)

↑ 29% from last year

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Challenges

• Clinical Database– Difficult to bring current and maintain

• Manpower issue– Medical tutorial and undergraduate students

• Demonstrating our value– Not a revenue generating service– Must be able to demonstrate cost savings

• Readmission, ED visits, LOS, expenditures• Treatment entry & engagement

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Pearls…

• Start building relationships now• Work out policies on information

exchange• Standardize procedures and documents• Clinical database

– Integration with Electronic Medical Record• Determine outcomes and plan for

measurement in advance