Table 6.

Summary of Takeaways Related to ACS Sustainment

PSAT Domain	Key Takeaways for Practitioners
Environmental Support (Including internal partnerships)	Facilitator:
	Stakeholder buy-in
	Broad recognition of the clinical need for OUD
	Leadership support
	Champions throughout the hospital
Funding Stability	Facilitator:
	Grant or other support for start-up phase
	Transition to a stable funding source including internal funding
	Barrier:
	ACSs typically do not earn a profit due to key staff members who cannot bill
Strategic Planning, Organizational Capacity	Facilitator:
	Cross-disciplinary relationships within the hospital
	Interprofessional staffing mix and cross-departmental participation
Monitoring and Evaluation	Facilitator:
	Monitoring and evaluating the ACS are considered crucial to sustainment
	Barrier:
	Metrics are not standardized or formalized within hospitals or across sites
External Partnerships	Facilitator:
	Relationships with community partners help ensure linkage from the hospital to ongoing care
Ongoing Barriers to ACS Sustainment	Additional barriers:
	Fee-for-service funding model is challenging, 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), impede referral and linkage to post-discharge care.
	Friction between hospital departments can impede ACS service delivery
	Workforce issues, such as finding staff to cover the ACS and staff turnover, are challenges for some ACSs