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Changing the Culture Within Hospitals to Make the Biggest Impact

September 10, 2019

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Consider this. A patient comes to the hospital time and time again. She has a substance use disorder and is seeking care for complications related to her SUD. In a cycle, she continues her drug use, her health continues to decline and she continues to come back to the hospital.  Eventually, she dies in the ICU, without getting connected to addiction treatment.

That loss made a profound impact on Dr. Honora Englander. She previously worked on a program to provide supportive care and transitional services to those who were uninsured or underinsured. She also discovered there was a blind spot in addressing addiction needs.

Dr. Englander conducted a survey of hospitalized adults with substance use disorders, and found that 58 percent of people with high risk alcohol use and 67 percent of people with high risk drug use wanted to cut back or quit. Her research identified barriers, including long wait times for community treatment, lack of resources for medically complex patients, and low patient trust in providers. She mapped findings from the needs assessment to components of an intervention.

And so the Improving Addiction Care Team (IMPACT) was created in July 2015. Dr. Englander is its director. She’s now board certified in addiction medicine. Through the program, doctors can refer hospitalized patients to receive care from IMPACT. The team consists of a group of doctors, social workers, nurse practitioners, physician’s assistants, and certified recovery mentors who meet every day. They identify and assess patients who’re suffering from addiction-related diseases and health problems and offer assistance with harm reduction and treatment.

“This increases engagement and trust, and helps them to navigate a complex system,” Dr. Englander explains.

IMPACT includes:

  1. An inpatient consult service, with the goal of giving patients a safe place to share their stories, improving patient engagement and trust while expanding inpatient treatment options.
  2. In-reach liaisons, which are, which are partnerships with community providers to create rapid access pathways to treatment and create a smooth transition for those MAT.
  3. Medically-enhanced residential treatment program that integrated IV antibiotics in residential care. This was eventually discontinued.

The program has served more than 1,400 patients in the past four years.

Project IMPACT has led to the creation of other hospital-based services. For instance, there is now a hospital-based Project ECHO. There is also a bridge clinic that will soon open to further address the needs of those with an SUD.

“People don’t come to the hospital looking for substance use treatment,” Dr. Englander explains. “But the fear of death can be a wakeup call. It creates a golden moment of opportunity where we can intervene and help people on a different path.”

MAT, rapid care, and helping patients navigate complex systems the program’s key features.

IMPACT is also changing the culture within the hospital. “Before IMPACT, physicians felt that hospitalization did not address addiction, leading to untreated withdrawal, patients leaving against medical advice, chaotic care, and the staff experiencing moral distress,” Dr. Englander says. “Since IMPACT, physicians now feel the approach to addiction is completely reframed as a treatable chronic disease, improving patient engagement and humanizing care.”


IMPACT was a featured award winner in the 2019 Innovation Now project of the Addiction Policy Forum.

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Mark Powell

J. Mark Powell is an author, former network journalist, and veteran communications expert. Read more about Mark Powell.