The Development of a Toolkit to Inform Unplanned Discharge Planning in Residential Substance Use Disorder Programs

Unplanned discharge is a common patient safety problem in residential substance use disorder (SUD) programs and is associated with harm. Staff behavior can contribute to unplanned discharge. There is a lack of guidance; however, regarding the steps that staff should take to prevent unplanned discharge and related harm. A toolkit was created to guide staff in implementing best practices to manage unplanned discharge in residential SUD programs.

An unplanned discharge toolkit was designed over three phases using an evidence-based framework. In phase 1, qualitative interviews were conducted with staff at 10 sites to determine toolkit content. Electronic databases and other sources were searched to locate best practices or policies. In phase 2, usability testing was conducted with content experts. In phase 3, a toolkit was drafted, and a validated survey was administered to staff to assess usability.

Surveyed participants completely agreed that the toolkit is acceptable and agreed that it appears feasible. A few participants identified ways to enhance the toolkit, and these recommendations were incorporated before finalizing the product.

This is the first study to develop a toolkit of best practices to prevent unplanned discharge and related harm in residential SUD programs. On the basis of preliminary findings, the toolkit may be acceptable and feasible to implement in residential SUD programs. Future work should evaluate the impact of the toolkit on processes and outcomes.