Table 5.

Summary of Themes from Qualitative Interviews

PSAT Domain	Theme
Environmental Support (Including internal partnerships)	Widespread stakeholder buy-in for initiating the ACS was common at most hospitals due to consensus around the need for OUD treatment among inpatients.
	Leadership support and having “champions” throughout the hospital have been critical to both the initiation and sustainment of ACSs.
Funding stability	Startup grants are ideal for ACS startup, but other approaches were also used for initiating ACSs.
	Varied, blended funding models are used to sustain ACS, but funding isn’t stable.
Strategic Planning, Organizational Capacity	Fostering and maintaining cross-departmental relationships throughout the hospital can help expand and sustain the ACS
	Having an interprofessional staffing mix and cross-departmental participation can increase capacity to sustain the ACS.
Monitoring and Evaluation	Monitoring and evaluating the ACS are considered crucial to sustainment, but for most ACSs monitoring with standardized metrics is not required by the hospital. Despite the lack of required metrics, many ACSs have created their own dashboards to monitor progress and quality.
	Metrics varied across hospitals.
External Partnerships	Relationships with community partners outside of the hospital are essential to ensuring linkage from the hospital to ongoing care, and to ACS sustainment.
Ongoing Barriers to ACS Sustainment	The fee-for-service funding model creates ongoing challenges for a full ACS, especially outside of academic settings.
	Lack of adequate methadone treatment services outside the hospital and barriers to linking patients on MOUD to acute care and skilled nursing facilities (SNFs) impedes referral and linkage to post-discharge care.
	Friction between hospital departments can impede ACS service delivery.