Treatment of Intravenous Substance Use Disorders in Hospitalized Patients with Endocarditis or Spinal Abcess

Grant Application

Dan Giesler, MD, UPMC Montefiore/UPMC Presbyterian

 

Proposed Innovation

Intravenous drug users are at a high risk of developing life-threatening infections, such as endocarditis — which can damage or destroy heart valves — and spinal abscess. During hospitalization, treatment normally focuses on the patient’s infection with little or no attention to the substance use disorder. These patients often return to the hospital for treatment of ongoing infections due to continued drug use.

With funding from the Beckwith Institute, this project aims to stop the vicious circle of continued substance use, frequent readmissions, and recurrent infections by providing injection drug users with treatment and starting drug rehabilitation while hospitalized.

 

Improvements in Action

Through this pilot project, the quality of care provided to injection drug users will be improved to encourage shared decision making between patients and clinicians throughout hospitalization. This will be accomplished by:

• Fostering a collaborative, multidisciplinary team through open lines of communication between specialty departments
• Training key health care providers on the use of a special screening protocol aimed at early identification and intervention of patients who are intravenous drug users
• Establishing a treatment protocol and starting the rehabilitation process while the patient is hospitalized
• Establishing a comprehensive discharge plan to foster continued outpatient rehabilitation treatment. Patients and families will also be given a discharge “tool kit” with information on resources available in their community, including drug rehabilitation centers, chronic pain management clinics, and crisis centers.

 

Results – In Progress

Treatment of endocarditis and spinal abscess typically requires a long hospitalization, intravenous antibiotics, and, sometimes, invasive surgeries. Patients undergoing treatment for these life-threatening infections are more likely to be motivated to start drug treatment.

Identifying and treating the underlying substance use disorder while patients are still hospitalized is expected to result in more patients entering treatment programs at the time of discharge. In addition, providing patient and family education and support will help ensure successful transition into the community with fewer relapses.