Table 4 Hospital referral services, barriers and facilitators to offering referrals for substance use disorder services
Variable | n | % |
|---|---|---|
Presence of an existing bridge clinic in or near the hospital that the ED uses to refer patients | ||
Yes | 25 | 29% |
No | 44 | 52% |
Do not know | 16 | 19% |
Services ED refers to: | ||
Behavioral health provider (e.g., psychiatrist, licensed counselor, etc.) | 57 | 67% |
Primary care provider | 48 | 56% |
Outpatient substance use treatment | 42 | 49% |
Inpatient substance use treatment | 35 | 41% |
Residential substance use treatment | 19 | 22% |
Buprenorphine treatment | 18 | 21% |
Opioid treatment program (i.e., methadone treatment) | 12 | 14% |
No referrals process in place | 9 | 11% |
Other | 8 | 9% |
Step down care within the hospital | 6 | 7% |
What are the top barriers to making warm hand-offs to other providers for follow-up care?a | ||
Our ED currently does not have a protocol for referrals | 42 | 49% |
Lack of staff who can coordinate hand-offs | 38 | 45% |
No partnerships with existing providers | 32 | 38% |
Lack of time to coordinate | 30 | 35% |
No providers nearby | 19 | 22% |
Patients not interested in handoffs | 17 | 20% |
Providers do not want to onboard patients who are in crisis | 11 | 13% |
Other | 11 | 13% |
No providers with availability for new patients | 6 | 7% |
No providers who accept Medicaid as payment | 1 | 1% |
Harm reduction | ||
Which of the following harm reduction services does your ED refer to community partners?a | ||
No referrals are made for harm reduction | 40 | 47% |
Local health department (safer use discussion/education, wound care kit, etc.) | 32 | 38% |
Take-home naloxone (community RX, mobile naloxone unit, etc.) | 21 | 25% |
Syringe access services (needle exchange program) | 18 | 21% |
Other | 6 | 7% |
Social Services | ||
Which of the following social services does theED refer patientswith substance use disorder?a | ||
Assistance obtaining Medicaid or other health coverage | 35 | 41% |
Assistance with transportation | 31 | 36% |
Housing resources | 26 | 31% |
None of the above | 26 | 31% |
Assistance navigating insurance benefits | 19 | 22% |
Documentation (e.g. ID card) | 17 | 20% |
Other | 13 | 15% |
What barriers does the ED face in providing services or referrals for social services?a | ||
ED does not have the capacity to contact patients after discharge to ensure care continuity | 52 | 61% |
Lack of partnerships with existing service providers | 39 | 46% |
Lack of service providers nearby | 41 | 48% |
Lack of service providers with availability for new clients | 26 | 31% |
Lack of staff to coordinate services or referrals | 43 | 51% |
Lack of time to coordinate services or referrals | 36 | 42% |
Patients are not interested in services or referrals | 30 | 35% |
Other | 10 | 12% |
What factors help your ED provide services or referrals for social services?a | ||
ED has a champion for connections to social services | 6 | 7% |
ED has existing partnerships with social service providers | 15 | 18% |
ED has follow-up care staff who contact patients after discharge to ensure care continuity | 11 | 13% |
ED has social services navigators on staff | 17 | 20% |
Other | 52 | 61% |