Patient navigation results in higher engagement rates in outpatient treatment after discharge from the emergency department.
A new study implemented a holistic intervention delivered by navigators for emergency department (ED) patients with substance use disorders. The study followed patients discharged from Highland Hospital, San Leandro Hospital, and Alameda Hospital EDs with cocaine, methamphetamine, alcohol, and opioid use-related diagnoses to assess their engagement in treatment in the month following their discharge from the ED, with and without navigator intervention.
Key Findings
Navigator-enhanced care significantly increased engagement.
Those receiving the navigator-enhanced care had over three times the engagement (50.4%) in outpatient treatment within 30 days of ED discharge compared to those who did not (15.9%).
“With this patient-centered approach, we are able to improve outcomes for patients during and after their emergency department visits. This team [ED providers and navigators], in addition to our low-threshold Bridge Clinic, has become a critical part of our health system’s approach to the treatment of substance use disorders.” – Erik Anderson, MD, Associate Research Director, Substance Use Disorder Program, Highland Hospital
Treatment engagement was improved for most substance use disorders.
The navigator intervention was associated with higher rates of treatment engagement for patients with alcohol, opioid, and cocaine-related diagnoses. However, patients with methamphetamine-related diagnoses had lower engagement rates with or without the navigator intervention.
Takeaway
“The substance use navigators are the heart and soul of the program,” says Erik Anderson, MD, Associate Research Director for the Substance Use Disorder Program at Highland Hospital. “They develop ongoing relationships with patients that extend beyond the walls of the emergency department.”
A whole-person care-informed intervention delivered by navigators for ED patients with substance use disorders is strongly associated with higher engagement rates in addiction treatment after discharge. This intervention is especially notable given that previous studies have demonstrated high mortality rates after opioid overdose ED visits, so immediate and sustained treatment is life-saving.
Additionally, substance use disorders commonly lead to hospital readmissions, which diminish patient outcomes and increase hospital expenses, further stressing hospitals. Effective interventions to treat substance use from the ED, such as staffing substance use navigators, are critical to saving lives and functional health systems.
“The reality is that most services for people using drugs are made up of multiple touchpoints that are uncoordinated and frequently changing. It is simply not possible to create a frictionless, coordinated experience for someone entering substance use disorder treatment without staff like substance use navigators, dedicated to this task.” – Andrew Herring, MD, Director of Research, Highland Hospital Department of Emergency Medicine, Systemwide Medical Director, Substance Use Disorder Treatment, Alameda Health System, Assistant Clinical Prof. University of California, San Francisco, and Co-PI and Co-Director, CA Bridge, Interim Director of Research, Highland Hospital
Consider sharing these findings with hospital leaders to encourage them to make navigators a part of the standard of care in your hospital.