SHM Converge Scientific Abstract ePoster Gallery-Optimizing Inpatient Treatment for Opioid Use Disorder Among Hospitalized Veterans: A Two-Phase Hospitalist-Led Quality Improvement Initiative

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This hospitalist-led quality improvement initiative aimed to optimize inpatient treatment of opioid use disorder (OUD) among hospitalized veterans at an urban 200-bed VA hospital. The project addressed a major care gap: hospitalization is often a missed opportunity to start medications for OUD (MOUD), despite strong evidence that inpatient initiation improves retention in treatment, reduces self-directed discharge, lowers readmissions, and decreases overdose and mortality.<br /><br />The initiative was conducted in two phases. Phase 1 (March 2021–August 2023) included targeted MOUD education, implementation of buprenorphine/naloxone prescribing support, an order set, and a request/approval process for addiction consultation. Phase 2 (September 2023–December 2024) introduced a dedicated addiction consult team.<br /><br />The patient population included 458 hospitalizations for OUD in patients not already on MOUD. The cohort was largely older, male, Black/African American, and had substantial social and substance-use complexity, including high rates of tobacco, cocaine, alcohol use, and housing insecurity.<br /><br />Results showed a marked improvement in MOUD prescribing over time. Baseline prescribing increased from 1.8% to 22.4% during Phase 1, and after the addiction consult team began, prescribing rose further to 74.7%. Naloxone prescribing and use of addiction consultation also improved. Common barriers to prescribing included failure to offer or discuss treatment, patient declination, deferral, self-directed discharge, provider comfort, prescribing restrictions, knowledge deficits, and challenges with outpatient linkage.<br /><br />The project demonstrates that a structured, multidisciplinary, hospitalist-led approach can dramatically improve inpatient OUD treatment. The authors plan to evaluate downstream outcomes such as readmission, sustained remission, mortality, length of stay, and cost-effectiveness, with the long-term goal of addressing OUD in every hospitalized veteran who needs it.

Asset Subtitle

Kelley Wachsberg

Meta Tag

Author List Alyssa Hyndman, Ashwin Sunderraj, Bijal Jain, Cheryl Conner, Elisabeth Poorman, Jillian Gomez, Jonathan Henry, Jude Al-Abosy, Kelley Wachsberg, Marci Laragh, Nisheka N. Vanjani, Samantha White

Category Research

Concept Hospitalization

Concept Opioid Use Disorder

Concept Medication for Opioid Use Disorder

Concept Buprenorphine-Naloxone

Concept Quality Improvement

Distinguished Finalist

Presenter Organization Northwestern Feinberg School of Medicine

Presenting Author Kelley Wachsberg

Track Quality Improvement

Keywords

opioid use disorder

medications for OUD

hospitalist-led quality improvement

inpatient initiation

buprenorphine/naloxone

addiction consult team

VA hospital

naloxone prescribing

hospitalized veterans

treatment retention

Hospitalization

Opioid Use Disorder

Medication for Opioid Use Disorder

Buprenorphine-Naloxone

Quality Improvement