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A National Survey of Approaches to Manage the Complex ICU Patient with Addiction
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A6044 - A National Survey of Approaches to Manage the Complex ICU Patient with Addiction
Author Block: A. Reichheld1, K. Hills-Evans2, J. Sheehan1, M. Tandon1, N. Tocci1, D. Hsu1, J. Marshall1, S. O'Donoghue1, J. Stevens1; 1Beth Israel Deaconess Medical Center, Boston, MA, United States, 2Massachusetts General Hospital, Boston, MA, United States.
Rationale: In the midst of a national epidemic, opioid-associated admissions to the intensive care unit (ICU) have increased substantially. Patients admitted with opioid overdose are at increased risk for preventable harms in the ICU, and mortality among these patients has also increased. Through a national survey, we sought to explore consensus on management of the critically ill patient with concomitant complex addiction needs.
Methods: A nationally representative sample of 300 hospitals was identified and ICU clinicians from each facility were invited to complete an online survey. Participants were identified by critical care directors as ICU clinicians familiar with the critical care guidelines at their institution. Surveys were emailed to consenting participants via REDCap (Nashville v7.0.10), and asked about guidelines for inpatient clinical management of opioid use disorder (OUD) and coordination of outpatient addiction resources. The existence of such guidelines was considered to be a reflection of an institution’s approach to meet the clinical needs of patients with OUD.
Results: Of the 300 hospitals contacted, 110 agreed to participate. 49 surveys were fully completed and four were partially completed, yielding a 48% (53/110) response rate. Slightly over half (53%, 27/51) of respondents were at least somewhat comfortable with the clinical management of patients with OUD, but 19% (10/53) were unsure about how to manage sedation for patients with OUD. Although 79% (41/52) of ICUs had a guideline for the titration of sedative analgesics, only 6% (3/50) of these guidelines specifically addressed the needs of OUD patients. 82% (41/50) of respondents either did not have or were unaware of a guideline to manage opioid withdrawal. Although the majority of respondents (78%, 38/49) sometimes or always continued patients on existing outpatient medication-assisted-treatment for opioid use disorder while in the ICU, only 3% (1/38) reported an institutional guideline to direct the use of such treatments. Most respondents (65%, 33/51) did not have access to an addiction or pain specialist in the ICU, and only 4% (2/48) had a dedicated addiction care specialist see patients before discharge. Upon discharge, 8% (4/49) of institutions provide naloxone and 40% (19/47) offer addiction care resources.
Conclusions: There is no consensus on the management of critically ill patients with OUD, and most ICUs lack treatment guidelines specific to this population. An increased focus on the specific critical care needs of this growing population is necessary to prevent harm and promote recovery.
Author Block: A. Reichheld1, K. Hills-Evans2, J. Sheehan1, M. Tandon1, N. Tocci1, D. Hsu1, J. Marshall1, S. O'Donoghue1, J. Stevens1; 1Beth Israel Deaconess Medical Center, Boston, MA, United States, 2Massachusetts General Hospital, Boston, MA, United States.
Rationale: In the midst of a national epidemic, opioid-associated admissions to the intensive care unit (ICU) have increased substantially. Patients admitted with opioid overdose are at increased risk for preventable harms in the ICU, and mortality among these patients has also increased. Through a national survey, we sought to explore consensus on management of the critically ill patient with concomitant complex addiction needs.
Methods: A nationally representative sample of 300 hospitals was identified and ICU clinicians from each facility were invited to complete an online survey. Participants were identified by critical care directors as ICU clinicians familiar with the critical care guidelines at their institution. Surveys were emailed to consenting participants via REDCap (Nashville v7.0.10), and asked about guidelines for inpatient clinical management of opioid use disorder (OUD) and coordination of outpatient addiction resources. The existence of such guidelines was considered to be a reflection of an institution’s approach to meet the clinical needs of patients with OUD.
Results: Of the 300 hospitals contacted, 110 agreed to participate. 49 surveys were fully completed and four were partially completed, yielding a 48% (53/110) response rate. Slightly over half (53%, 27/51) of respondents were at least somewhat comfortable with the clinical management of patients with OUD, but 19% (10/53) were unsure about how to manage sedation for patients with OUD. Although 79% (41/52) of ICUs had a guideline for the titration of sedative analgesics, only 6% (3/50) of these guidelines specifically addressed the needs of OUD patients. 82% (41/50) of respondents either did not have or were unaware of a guideline to manage opioid withdrawal. Although the majority of respondents (78%, 38/49) sometimes or always continued patients on existing outpatient medication-assisted-treatment for opioid use disorder while in the ICU, only 3% (1/38) reported an institutional guideline to direct the use of such treatments. Most respondents (65%, 33/51) did not have access to an addiction or pain specialist in the ICU, and only 4% (2/48) had a dedicated addiction care specialist see patients before discharge. Upon discharge, 8% (4/49) of institutions provide naloxone and 40% (19/47) offer addiction care resources.
Conclusions: There is no consensus on the management of critically ill patients with OUD, and most ICUs lack treatment guidelines specific to this population. An increased focus on the specific critical care needs of this growing population is necessary to prevent harm and promote recovery.
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