Increasing inpatient substance use disorder screening: Brief intervention and referral to treatment

Problem & Purpose: Improving substance use disorder (SUD) screenings can enhance patient outcomes by increasing access to treatment. Hospitalization provides an opportunity to connect individuals with SUD to care. In Spring 2024, the Vascular Surgery Progressive Care Unit at a large academic medical center had a SUD screening rate of only 40%, well below the institutional goal of 100%, which delayed referrals and impacted patient outcomes. This quality improvement project aimed to increase screening rates to 100% by implementing the NIDA Single-Question Screening Tool, an evidence-based intervention.

This 15-week project occurred in the Fall of 2024 in a 12-bed Vascular Surgery Progressive Care Unit. Nursing staff integrated the screening tool into the electronic medical record. Once completed, they informed the Vascular Surgery Team during Interdisciplinary Rounds, prompting a provider consultation with the Substance Abuse Consultation Service (SACS) for further evaluation and referral. Weekly run charts tracked process and outcome measures, including screening completion rates and referrals.

The screening rate increased from 40% to 74.2%. Among patients who screened positive for possible substance use, 86% (n = 7) were referred for provider evaluation, and 100% (n = 6) of those were referred for treatment.

Findings demonstrated that a nurse-driven screening algorithm significantly improved referral rates, aligning with previous research. Routine SUD screening and referral are well-supported, evidence-based interventions. The project brought screening rates closer to the institutional goal and highlighted the impact of structured interventions in improving SUD identification and treatment access.