Northwell Health has implementated of its substance-use screening protocol for patients who are admitted to its hospitals, broadening its ability to support members of the community at risk of health consequences related to the use of opioids or other substances.
The initiative, which uses the health system's Screening, Brief Intervention and Referral to Treatment (SBIRT) program, expands Northwell's effort to address opioid and substance use as effectively and compassionately as any other health care problem by making screening part of the standard of care for every patient.
"By asking just a few evidence-based questions of every willing patient who is admitted to the hospital, we're making it clear that they're not alone and that we can help them get effective care and treatment. That kind of caring offer of partnership can make a profound difference with such a highly stigmatized issue," said Sandeep Kapoor, MD, director of Northwell's SBIRT program.
This implementation of inpatient SBIRT at 12 of the 19 hospitals that Northwell owns and operates in the New York area is in line with a newly issued draft recommendation from the U.S. Preventive Services Task Force, which advises universal screening of adults for the use of illegal drugs, or the nonmedical use of prescription psychoactive medications. It is the latest step in a broad, multi-layered campaign at the health system. Northwell has been using SBIRT to screen patients at select primary care practices for the past few years. In addition, an age-appropriate version of the program has been in place at Northwell's Cohen Children's Medical Center since January 2018 for patients 12 and older. In May, Northwell announced that the SBIRT protocol is being integrated into care at all its emergency departments (EDs) -- it is currently in use in 14 Northwell EDs.
Across all of these settings Northwell clinical teams have performed nearly one million SBIRT screenings over the past 5.5 years. With the expansion of SBIRT to Northwell's hospitals, an additional half million patients are expected to be screened in the upcoming year.
As part of the rollout in Northwell's hospitals, newly admitted patients will be asked two to four standardized questions about their use of alcohol and other drugs, including opioids. If the answers reveal a patient is experiencing adverse consequences of substance use, the clinical team will explore further. In cases where answers indicate a substance use disorder or a high risk of developing it, team members will work with the patient to develop a care plan that may include a referral for substance-use treatment after discharge.
Early data collected at hospitals using SBIRT shows that even when people are asked about their substance use when they come into the emergency department, it can be productive to raise the topic again when they are admitted to the hospital. About 10 percent of patients questioned about their substance use in the emergency department have a positive pre-screen result, meaning their answers reveal enough risk to provoke a more in-depth conversation. When patients are asked again after admission, up to 15 percent have a positive pre-screen result. In addition, the repetition adds continuity of care.
"Those early results showed us that there is a benefit in asking patients these questions at every touchpoint, just like we repeat other vital signs," said Dr. Kapoor. "Having this conversation signals to our patients that we care and that we're here to help, just as we would be for any other medical condition. When they're ready, we want to partner with them to help them get the treatment they need."
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