Editor's note: Established in 2001, the James W. West, MD, Quality Improvement Awards recognize member organizations of the National Association of Addiction Treatment Providers (NAATP) that improve the quality and effectiveness of their services and document their results along the way.
The award is named in honor of James W. West, a longtime quality improvement advocate and medical director emeritus at the Betty Ford Center. Award recipients will be honored at the annual NAATP conference, held May 19-22 in Phoenix.
This, the 12th annual award, recognizes three programs whose efforts demonstrate comprehensive approaches to effective, continuous quality improvement. One of three recipients this year, Gosnold on Cape Cod was recognized for partnering with a general hospital to integrate care and reduce alcohol-related complications.
Gosnold on Cape Cod shares a campus with Falmouth General Hospital, a 90-bed medical/surgical facility that had been experiencing high rates of complications for patients with alcohol-related health problems.
A few years ago, Falmouth staff had several concerns they felt needed to be addressed—namely, ICU transfer rates at around 50% and average stays of 14 days for alcohol dependent patients admitted for unrelated medical conditions.
According to Raymond Tamasi, president and CEO of Gosnold, Falmouth patients were experiencing withdrawal symptoms that progressed to the point of requiring intubation, in addition to frequent bouts of delirium tremens due to unidentified or undertreated symptoms of withdrawl.
In November 2010, Gosnold management was asked to help Falmouth solve the problem and help its staff members improve their understanding of addiction.
They started working with Falmouth to develop a consultation service aimed at revamping hospital protocols and screening tools, training nurses about addiction, creating work-based learning opportunities for hospital nurses, and delivering clinical services at the patient’s bedside.
“The core of this improvement project was to establish a consultation relationship with the hospital where our staff not only did training, but helped them to learn how to better manage withdrawal,” explains Tamasi. “It was an opportunity to inject addiction treatment into primary care.” Gosnold evaluated protocols for how nurses screened patients and treated withdrawal, and later provided instruction on how to improve withdrawal symptom scoring.
According to Tamasi, while the education helped, it was also essential to address negative stereotypes and attitudes about addiction. To that end, one- and two-day rotations were implemented to give the nursing staff an opportunity to work in Gosnold’s acute care unit.
“We paid them a stipend so that they could attend all of the patient and group therapy sessions,” explains Tamasi. “There was a significant transformation attitudinally. I’d say that was one of the most dramatic experiences in the whole project.”
In their evaluations, nurses said the most significant part of their experience was sitting in a group therapy session, because they “saw a person who was struggling with an illness, not just someone who was making life miserable for all the people around them.”
“After we started doing bedside mentoring and coaching, [the nursing staff] started to screen better and medicate more effectively,” Tamasi said. “They began to anticipate better, and not compartmentalize patients by stereotype. They asked patients questions to elicit information about their pattern of use with alcohol.”
The approach to patient consults also evolved. Early on, patients were asked if they wanted a Gosnold counselor to come speak with them. After most turned it down, Tamasi suggested that the nurses simply stop asking.
Now, referrals to speak with a Gosnold specialist are treated no differently than any other consult at the hospital. Over 200 patients have benefited from the change.
The goal all along, notes Tamasi, was to find ways to “move addiction treatment off the sidelines of healthcare into the mainstream.” Now ICU transfer rate are down to 10% and average length of stay for patients who have received consultations is less than five days.
In addition, 85% of the patients who received consults at the hospital had never set foot at Gosnold, which means a “new cohort of patients” are finally receiving the treatment they need.
According to Dennis Gilhousen, president and CEO of NAATP, Golnold’s program represented a “microcosmic illustration of a macrocosmic issue,” referencing the barriers that often prevent hospitals and treatment providers from working together effectively.
“This was a genuine effort to put all of that aside, and in the interest of better patient care for both entities, to integrate the care of the patient,” Gilhousen says. “It was a brave effort to do something that made a difference.”
While efforts to develop formal relationships are frequently attempted, he says that’s exactly what Gosnold has done. “They’ve integrated care to make it seamless from the acute hospital to the residential treatment program.”
Photo caption: The leaders of the Gosnold/Falmouth Hospital partnership are (l-r) Dennis Bates, Gosnold Addiction Counselor; Susan Fields, Gosnold Addiction Counselor; Margaret Shapiro, Falmouth Hospital Addiction Liaison; Susan Wing, Falmouth Hospital COO; and Raymond V. Tamasi, Gosnold CEO.