Characterization of Patient-Directed Discharge in Patients with Substance Use Disorder(s)

Abstract

Background: This study aims to characterize patients with patient-directed discharge (PDD) and substance use disorders (SUD) and to summarize involvement of an Addiction Consult Service (ACS) in encounters resulting in PDD in an urban academic medical center. Methods: This single-center, retrospective, pre-and post-implementation study included patient encounters for hospitalized adults with at least one documented SUD and a PDD. The pre-and post-implementation periods were defined as July 2018–June 2019 and July 2020–June 2022, respectively. The primary outcome was a comparison of PDD rates between cohorts. Secondary outcomes were hospital length of stay (LOS) and 30-day read-mission rates. In the post-implementation cohort, ordering of and completion of an ACS consult and time to order and time to completion of the consult were assessed. For the subgroup with OUD, severity of withdrawal symptoms, utilization of methadone and/or buprenorphine in the first 24 h of admission, and rate of buprenorphine discharge prescribing were described. Differences in categorical variables between cohorts were analyzed using Chi-square or Fisher’s exact test and continuous variables were analyzed using the Student T -test or the Wilcoxon Rank Sum, as appropriate. Results: A total of 346 encounters (pre n = 101 and post n = 245) comprised of 252 unique patients were included. Patients were median 41 years old (IQR 33–54), 65.9% male, and 49.1% white. OUD (57.5%) was the most common SUD diagnosis among encounters and 40.8% were associated with more