hp
Search
Representation of communication and resolution strategies in clinical care
View Expert Insights

October • 9 • 2025

Inpatient Addiction Consult Services: Balancing Innovation and Liability

Article

Kerri Aramini, MJ, BSN, RN, CPHRM, LNC

share

Summary

With thoughtful planning, implementation, and risk management strategies, inpatient ACS can improve outcomes and ensure more effective treatment for patients.

Substance use disorder (SUD) continues to impose a growing clinical and operational burden on U.S. healthcare systems, as hospitals are experiencing a marked increase in admissions of patients with SUD-related complications. Many patients require prolonged courses of intravenous (IV) antibiotics to treat serious infections, such as endocarditis, osteomyelitis, and skin and soft tissue infections. This can present a challenge in care coordination, discharge planning, and infection control due to the complex intersection of acute illness and addiction.
 
Compounding the strain is the often extended duration of hospital stays for these patients. Stays are prolonged not only by the nature of their infections, but also by social and behavioral health factors that limit outpatient treatment options, including lack of safe housing or adherence concerns related to active substance use. Many hospitals are responding to these challenges by implementing inpatient addiction consult services (ACS). These programs, which have been shown to improve outcomes, use hospitalization as an opportunity engage patients and initiate SUD treatment during the impatient stay.
 
This care model represents a progressive, patient-centered approach to addressing SUDs in acute care settings, integrating addiction medicine consult teams (typically consisting of addiction specialists, psychiatrists, social workers, peer recovery coaches, and case managers) into hospitals to:
  • Identify and treat patients with SUDs.
  • Start medication-assisted treatment (MAT).
  • Provide harm reduction education.
  • Connect patients with post-discharge recovery services.
The development of inpatient ACS reflects a broader trend toward integrated, patient-centered care, recognizing the need for sustained, community-linked treatment strategies to effectively address addiction. Hospitalization presents an opportunity to engage patients with SUDs in treatment, with many wanting to stop using and taking medications for opioid use disorder. 


Risk Recommendations


Effective implementation of an inpatient ACS program requires proactive risk management strategies to mitigate challenges and enhance patient outcomes. Consider the following when planning, designing, and implementing an ACS program at your organization:
  • Do your homework. Understand that an inpatient ACS program requires investment of financial, clinical, and human resources. Research ACS models from reputable organizations and determine which model and/or practices will work best. Evaluate the cost of implementing a program and consider the benefits it could bring to your organization. Share key learnings with the governing body, leadership, and other thought leaders in your organization. Collaborate with an interdisciplinary team to determine whether your organization has the resources, capacity, and ability to build and support an ACS program.
  • Develop policies and procedures. Inpatient addiction consult service programs involve diverse roles, which can lead to role confusion or scope of practice issues. Ensure that policies and procedures for ACS teams address the following: 
    • Defining clear roles, responsibilities, and documentation expectations.
    • Implementing protocols for clinical handoffs and shared care plans.
    • Credentialing and privileging team members, especially for peer recovery support roles.
    • Regularly review policies and procedures related to SUD treatment to ensure they align with current best practices.
  • Create risk assessments and protocols. Develop and utilize structured tools, including risk assessments, screening protocols, medication protocols for buprenorphine induction, and patient safety care plans. These tools help to manage risks associated with in-hospital drug use and set clear expectations for both patients and staff.
  • Educate staff. Stigma surrounding SUD can be a barrier to providing care. Educate staff to reduce this stigma and improve understanding of SUDs. Changing hospital culture around SUDs is crucial for improving patient care and outcomes.
  • Coordinate post-discharge care. Establish strong post-discharge care coordination and referral processes with community treatment programs. Post-discharge care coordination and maintenance of relationships with community treatment programs are essential for continuity of care.
  • Monitor and evaluate data. Continuously monitor and evaluate patient outcomes to identify potential risks early. Utilize real-time data analytics to help the care team adjust and refine strategies in response to emerging threats and changing patient needs. Incorporating staff, patients, and clinician feedback into this effort helps to build team resilience and enhances the overall efficacy of risk management practices.
With careful planning, thoughtful implementation, and proactive risk management strategies, inpatient ACS can improve outcomes, minimize risk, and ensure a safer and more effective treatment environment for vulnerable patients. 

 

Tags

  • Risk Management & Patient Safety

share