The BIG Hospital SBIRT Initiative

A Learning Collaborative to Expand SBIRT into Hospitals and Other Medical Settings

Hospital Alcoholism Consult Program at Gosnold on Cape Cod; Early State: Early Intervention for Substance Use in Pregnancy


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Raymond Tamasi, CEO of the substance use treatment program Gosnold on Cape Cod, presents the first year results of an exceptionally promising collaboration between Falmouth Hospital and Gosnold.  Here is a teaser: Liaison-nurses from Gosnold conducted withdrawal consultations for medically-ill patients on Falmouth inpatient services.  Of the first 115 patients counseled, only 10% of patient required transfer to the Intensive Care Unit, compared with 50% ICU referrals previously. Average length of hospital stay among consult patients was 6.2 days, less than half the 14.7 days of comparable patients prior to the start of the consultation program. ALOS for withdrawal consult patients referred to the ICU was 2½ times that of patients whose treatment was confined to a med-surg floor. Few patients had an admissions diagnosis of substance use disorder, and 35% of the patients who received withdrawal consultations had an admission diagnosis of a gastrointestinal disorder. Nearly half (44%) of patients accepted a referral to an addiction specialty program following the inpatient counseling intervention. 

Nancy Goler, MD, directs the Early Start program, an innovative, effective and cost-effective screening, brief intervention and follow-up program for substance using pregnant women that has been operating at Kaiser Permanente Northern California since 1990.  Dr. Goler describes the program and the clinical and cost/benefit results, as well as the training & technical support resources necessary and available to replicate the program.   This is a terrific demonstration of delivering screening, brief intervention and follow up for a high risk population.  It is highly adaptable for hospitals with large OB/GYN ambulatory programs, Accountable Care Organizations, HMOs, and other settings serving pregnant women. 

Raymond Tamasi, CEO, Gosnold on Cape Cod (MA) & Dr. Nancy Goler, Director of Early Start program at Kaiser Permanente (California)