Table 4.
Hospital referral services, barriers and facilitators to offering referrals for substance use disorder services
| Variable | n | % |
|---|---|---|
| Presence of an existing bridge clinic in or near the hospital that the ED uses to refer patients | ||
| Yes | 25 | 29% |
| No | 44 | 52% |
| Do not know | 16 | 19% |
| Services ED refers to: | ||
| Behavioral health provider (e.g., psychiatrist, licensed counselor, etc.) | 57 | 67% |
| Primary care provider | 48 | 56% |
| Outpatient substance use treatment | 42 | 49% |
| Inpatient substance use treatment | 35 | 41% |
| Residential substance use treatment | 19 | 22% |
| Buprenorphine treatment | 18 | 21% |
| Opioid treatment program (i.e., methadone treatment) | 12 | 14% |
| No referrals process in place | 9 | 11% |
| Other | 8 | 9% |
| Step down care within the hospital | 6 | 7% |
| What are the top barriers to making warm hand-offs to other providers for follow-up care? a | ||
| Our ED currently does not have a protocol for referrals | 42 | 49% |
| Lack of staff who can coordinate hand-offs | 38 | 45% |
| No partnerships with existing providers | 32 | 38% |
| Lack of time to coordinate | 30 | 35% |
| No providers nearby | 19 | 22% |
| Patients not interested in handoffs | 17 | 20% |
| Providers do not want to onboard patients who are in crisis | 11 | 13% |
| Other | 11 | 13% |
| No providers with availability for new patients | 6 | 7% |
| No providers who accept Medicaid as payment | 1 | 1% |
| Harm reduction | ||
| Which of the following harm reduction services does your ED refer to community partners? a | ||
| No referrals are made for harm reduction | 40 | 47% |
| Local health department (safer use discussion/education, wound care kit, etc.) | 32 | 38% |
| Take-home naloxone (community RX, mobile naloxone unit, etc.) | 21 | 25% |
| Syringe access services (needle exchange program) | 18 | 21% |
| Other | 6 | 7% |
| Social Services | ||
| Which of the following social services does the ED refer patients with substance use disorder? a | ||
| Assistance obtaining Medicaid or other health coverage | 35 | 41% |
| Assistance with transportation | 31 | 36% |
| Housing resources | 26 | 31% |
| None of the above | 26 | 31% |
| Assistance navigating insurance benefits | 19 | 22% |
| Documentation (e.g. ID card) | 17 | 20% |
| Other | 13 | 15% |
| What barriers does the ED face in providing services or referrals for social services? a | ||
| ED does not have the capacity to contact patients after discharge to ensure care continuity | 52 | 61% |
| Lack of partnerships with existing service providers | 39 | 46% |
| Lack of service providers nearby | 41 | 48% |
| Lack of service providers with availability for new clients | 26 | 31% |
| Lack of staff to coordinate services or referrals | 43 | 51% |
| Lack of time to coordinate services or referrals | 36 | 42% |
| Patients are not interested in services or referrals | 30 | 35% |
| Other | 10 | 12% |
| What factors help your ED provide services or referrals for social services? a | ||
| ED has a champion for connections to social services | 6 | 7% |
| ED has existing partnerships with social service providers | 15 | 18% |
| ED has follow-up care staff who contact patients after discharge to ensure care continuity | 11 | 13% |
| ED has social services navigators on staff | 17 | 20% |
| Other | 52 | 61% |
aSelect all that apply question, percentages may exceed 100%