163 Implementation of a Telephonic-Based Model to Continue to Address Substance Use as Part of Usual Care in Emergency Departments during COVID-19

ABSTRACT

Study Objectives: Alcohol is associated with increased risk of hypertension and diabetes, which are associated with increased morbidity and mortality from COVID-19, as are opioids and methamphetamine. Our institution has a Screening, Brief Intervention, and Referral to Treatment (SBIRT) program in 18 emergency departments (EDs), 14 inpatient hospitals, and 5 primary care sites to universally address substance use with patients as part of usual care. As our region has a high prevalence of COVID-19, we had to minimize staff presence in the ED, including health coaches and social workers who normally work with patients with a positive SBIRT screen. The COVID-19 crisis demanded innovation;we implemented a “Telephonic SBIRT” (T-SBIRT) model to continue to address patients’ substance use in the context of physical and mental health while minimizing in-person interactions. Methods: Due to regulations regarding “non-essential” staff, 11 SBIRT Health Coaches were removed from their ED and primary care sites. Health Coaches were assigned to T-SBIRT where a central phone number forwards to the mobile phone of the remote health coach on duty. Shifts cover 8am-12am, 7 days per week. We developed a flyer with the services, hours, and phone number and broadly disseminated to ED chairs, primary care providers, nurse managers, all hospital social workers, the Health Home team, and others via virtual meetings and email. We developed a HIPAA-compliant Research Electronic Data Capture (REDCap) form for Health Coaches to use to document services, including the questions for AUDIT (alcohol) and DAST-10 (drug) full screens and checkboxes for brief interventions, referrals to treatment, and virtual resources provided (AA/NA, BottleCap for reducing alcohol use, tobacco cessation, etc). We developed a system via REDCap where the Health Coach emailed the caller the resource list from a central email address in real time. Finally, we developed a REDCap form to virtually obtain HIPAA consent to enroll participants in our substance use disorder care navigation program (Project CONNECT). Results: In 13 weeks, we had 422 phone calls, 228 (54%) incoming, 190 (45%) outgoing, and 4 (1%) voicemails. 108 (26%) of calls were with patients, 13 (3%) with family/friends, 224 (53%) with staff members, and 79 (19%) with treatment providers. Calls stemmed from 14 hospitals, 2 primary care practices, and Health Home. We worked with 69 unique staff members and 94 unique patient cases, 75 (81%) male, 20 (19%) female, and 7 (8%) in Spanish. We provided 73 full screens, (91% high-risk), 47 brief interventions, referrals for 84 patients, emailed virtual resources to 40 individuals, and enrolled 16 patients in Project CONNECT. Conclusion: We were able to have a health coach provide T-SBIRT services for patients from sites that do not normally have a health coach, and cover weekends and later hours. Since calls received were for patients with high-risk substance use in need of a referral to substance use disorder treatment, more frontline provider education is needed on the ability of the T-SBIRT Team to address the full spectrum of substance use, not just high-risk substance use. In conclusion, T-SBIRT is a model that we plan to sustain to continually expand reach, and to provide services to address substance use as part of usual care with patients at more locations than we could otherwise physically staff.