Multidisciplinary perspectives on a new hospital addiction consult service: a mixed-methods study

Abstract

Hospital-based Addiction Consult Services (ACS) are increasingly implemented to improve care for patients with substance use disorders (SUD). While ACS are generally well-regarded, healthcare professionals of various roles may hold different perceptions of their impact. We conducted a web-based survey of physicians, advanced practice providers (APP), and nurses at a Philadelphia academic hospital from August-September 2024, 16 to 17 months after ACS implementation. The survey assessed attitudes and perceptions of the ACS with 6 questions using a 5-point Likert scale. These data were integrated with results from semi-structured interviews with physicians, advanced practice providers (APPs), and nurses from November 2023-January 2024, 7–9 months after ACS implementation, to provide a richer understanding of provider perspectives on the impact of the ACS. We used descriptive statistics to characterize the samples and analyzed survey data by healthcare professional group chi-squared tests. Interviews were analyzed using thematic content analysis. Of 793 healthcare professionals surveyed, 311 responded (39%), including 128 nurses (41%), 108 resident physicians (35%), 49 attending physicians (16%), and 26 APPs (8%). Most providers reported that the ACS positively impacted patient care. Significantly fewer nurses reported perceived improvements in quality of care and communication compared to other healthcare professionals (43–63% nurses vs. 77–98% other healthcare professionals, p  < 0.001, for 5 of 6 questions). While qualitative feedback was positive across groups, nursing interview narratives emphasized communication gaps, limited integration between nursing and the ACS, and a desire for additional training and education around SUD care. While most providers reported positive impacts of the Addiction Consult Service, nurses perceived fewer benefits than physicians and advanced practice providers. Qualitative findings suggest these differences stem from communication gaps, limited integration of nursing into ACS workflows, and barriers to SUD education. Implementation strategies that strengthen communication with bedside nurses and expand structured SUD education may improve multidisciplinary engagement and maximize the impact of ACS models.