Warm Handoff to Ongoing Treatment

It’s not uncommon for EDs to serve as the catalyst for motivating change behavior in a patient living with a chronic illness. For patients with substance use disorder, their recovery journey may begin during a crisis in their illness – just like a patient with heart disease. Just the same, it does not necessarily take a crisis event for patients to make health changes and we may never know when someone is ready to change health behaviors related to their illness. Therefore, it is important services ranging from formal treatment, peer support groups, harm reduction services, and social supports (housing, food, employment, transportation, etc.) are offered to every patient. 

Building the infrastructure within the ED for warm handoffs requires substantial resources. However, the payoff for patients receiving the right care in the community may help lower future ED visits and re-admissions. Additionally, ED staff may feel more effective in their ability to connect patients to ongoing care, which serves as a protective factor against healthcare worker burnout.  

Key Takeaways for the ED 

    1. Establish a clear protocol for how to engage patients after they leave the ED. This could include decision trees on who is flagged for a warm handoff protocol, frequency of check-ins, and how many attempts are made to engage a patient after discharge. 
    2. Hire dedicated staff for warm handoffs such as (but not limited to) a social worker or certified peer support specialist. Simply adding warm handoffs to an existing job description won’t be effective. 
    3. Consider implementing warm handoff protocol simultaneously with peer services. Based on NCHA ED Peer Support Pilot findings, peers are effective when they meet patients in the community for their first treatment appointment, peer support meeting (e.g., Narcotics Anonymous, Alcoholics Anonymous), or harm reduction visit. 
    4. The role of harm reduction cannot be overstated; even if a patient is not ready for a treatment referral, make sure the patient is connected with their local syringe exchange program or other harm reduction efforts. Harm reduction limits the spread of diseases and may serve as a stepping stone for long-term treatment.
    5. To demonstrate return on investment, build a dashboard of metrics to measure the effectiveness of dedicated staff to focus on warm handoffs. Key metrics to measure includes average length of stay, return visits to the ED, and 30-day readmissions.
    6. Families and loved ones may play a critical role in a patient’s recovery journey. Provide information to family and loved ones about follow up care along with resources for a loved one supporting someone with substance use disorder. Resources like nar-anon and al-anon are a good first step.

Resources to Get You Started

Pennsylvania’s Warm Handoff Care Map 

AnchorED Program in Rhode Island 

NCCARE 360, an online platform for community-based referrals led by the NC Department of Health and Human Services and the Foundation for Health Leadership and Innovation.

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