Linking Patients to Residential Substance Use Disorder Treatment Through Peer Coaches and a Clinical Decision Unit

Efforts to improve substance use disorder (SUD) care in the emergency department (ED) include deploying peer recovery coaches (PRCs). PRCs operate through a window of lived experience, providing motivational interviewing and linkage to recovery resources. This may include placement into residential treatment, which can be difficult from the ED given time constraints. We describe a novel clinical decision unit (CDU) pathway wherein PRCs facilitated discharge to residential SUD treatment.

We performed a retrospective analysis of patients presenting to a single hospital between June 2023 and May 2024. The sample was drawn from the consult list of PRCs. Data were obtained through direct export and manual extraction from the medical record. We performed χ² analyses to evaluate the effect of patient factors on pathway success.

In total, 75 encounters were included: 49 men (65.3%), 26 women (34.7%); age range, 18 to 69 years (median, 45 years). Forty-nine (65.3%) encounters were identified as Black, 19 (25.3%) as White, and 7 (9.3%) as other; 24 (32%) had a primary ED diagnosis related to substance use, and 38 (50.6%) had a primary psychiatric diagnosis (eg, suicidal ideation). PRCs placed 53 patients (70.6%) in residential treatment. Three patients had a change in clinical status and were admitted to the hospital. Median CDU length of stay was 27 hours (IQR, 21-44 hours). Forty-five (85%) of those placed were insured. Of the 15 uninsured patients, 8 (53%) were placed. No differences in pathway success were observed based on race, insurance status, or primary substance used. The pathway was more successful for men than for women (difference between groups, 34%; 95% CI, 10%-56%). The most common reason for pathway failure was patient-directed discharge (10 [45.5%] pathway failures).

In this CDU pathway, PRCs were able to place the majority of patients into residential SUD treatment. Further study is required to examine long-term patient outcomes.