Team-Based Care Solves Safety Problem of Discharging OUD Patient With PICC

Back to table of contents Previous article Next article Clinical how could it not be seen and felt as such from his perspective?Challenged by his question, I turned to the literature, and although there are limited data regarding best practices for discharging patients requiring a PICC for TPN administration, an emerging body of literature suggests this practice can be safe among a similar patient population—patients who inject drugs and require outpatient antibiotic therapy. Evidence suggests that patients who inject drugs can be safely discharged on antibiotic therapy and have similar rates of mortality, completion of antibiotic therapy, and line-related complications, but they experience higher rehospitalization rates compared with patients who do not inject drugs, according to Suzuki and colleagues in the Open Forum Infectious Diseases. When medications for opioid use disorder (MOUD) are prescribed for OUD patients who inject drugs, they have better outcomes including improved adherence to antibiotic therapy, decreased risk of re-infection, and reduced overdose mortality. Despite these optimistic findings, less than 20% of patients with OUD received MOUD, per Price et al. in the Journal of Infectious Diseases. I was not surprised that my patient encountered many of the barriers described by Calcaterra et al. in the Journal of Hospital Medicine, as reasons for this low prescription rate, including a lack of clear guidelines, sparse experience and education in prescribing MOUD and caring for patients with substance use disorders among nonpsychiatrists, and stigma.Mental health awareness starts with us as psychiatrists; we must be the leaders to bring this awareness to physicians in other specialties. We have the privilege of being the experts in harm reduction and caring for patients with substance use disorders and can lend this expertise to our nonpsychiatrist colleagues in the inpatient setting through the use of integrated care models. We have seen great results in improving health care outcomes, lowering costs, and reducing disparities with Collaborative Care models in the outpatient setting.However, there are fewer models, other than the consultant model, that I have seen in the hospital. A major limitation of the consultant model is that the onus of initiating a consultation is on the primary team, who may lack the knowledge to recognize the need for, or benefits of, a consultation. Use of clinical decision support tools, systems-wide order sets, greater collaboration between psychiatrists and physicians in other specialties, and automatic consults for certain clinical scenarios are some ideas that could improve psychiatrists' involvement in caring for the needs of complex hospitalized patients.Thankfully, the collective anxiety my team felt was relieved following collaboration with the addiction psychiatry team. Together, we were able to come up with an evidence-based plan grounded in the principles of harm reduction that both the patient and other providers agreed to, which involved initiation of buprenorphine, connection with outpatient substance use treatment, and discharge home with a PICC.Mental health awareness must start but cannot end with psychiatrists; our leadership and expertise are needed by both our health care systems and patients in developing and running integrated care models within the inpatient setting. ■Ruth Bishop, M.D., M.B.A., is a second-year resident in the combined program of internal medicine and psychiatry at the Medical University of South Carolina, an APA Public Psychiatry Fellow. and a fellow member of the Committee on Advocacy and Government Relations. ISSUES NewArchived