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

Background: 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, clinicians of various roles may hold different perceptions of their impact. Methods: We conducted a web-based survey of physicians, advanced practice providers (APP), and nurses at a Philadelphia academic hospital from August-September 2024, approximately 18 months years 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, APP, 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 clinician group chi-squared tests. Interviews were analyzed using thematic content analysis. Results: Of 793 clinicians 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. Surveyed nurses reported significantly smaller perceived improvements in quality of care and communication compared to other clinicians (43-63% nurses vs. 77-98% other clinicians, 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. Conclusions: While inpatient ACS improve key aspects of SUD care across professional groups, their impact may be enhanced through intentional integration of all frontline providers. Embedding nurses or nurse educators into ACS structures, strengthening multidisciplinary collaboration, and providing standardized SUD training may enhance team cohesion and ensure that all providers feel equipped and supported in caring for patients with SUD.