Integration with Physical Health Care

Improving medical staff perceptions and treatment outcomes for hospitalized patients with addictions: A general hospital/addiction treatment provider collaboration changes attitudes of hospital staff and improves patient care.


  • Falmouth Hospital, a general hospital on Cape Cod
  • Gosnold on Cape Cod, an addiction treatment provider

The Issue

Twenty-five to 30% of hospital admissions are alcohol related, yet withdrawal is often not recognized or managed consistently in hospital settings.  Negative perceptions and an inability to consistently recognize symptoms of withdrawal in the hospital’s Medical/Surgical unit led to longer hospital stays and a high transfer rate to the Intensive Care Unit (ICU).  In addition to the clinical impact on patients of not managing withdrawal, costs are 30%-40% lower in the Med/Surg unit than in the ICU.  Falmouth Hospital and Gosnold were located near each other, but did not coordinate care; staff from the two did not interact.

Joint Intervention

  • Addiction education and sensitivity training were implemented for nurses and physicians.
  • Simultaneously, a consultant team, comprised of staff of the treatment facility and the hospital, was available to hospital staff to help manage patients undergoing alcohol withdrawal.


The pilot and follow-on (total of 16 months) demonstrated that initial results were sustained

  • Medical Staff attitudes and perceptions about addicted patients had improved
  • Average Length of Stay decreased from 14.6 days to 6.2 days
  • Transfers to the ICU dropped from 50% to 11%.


The project was extended, and the consultant team was augmented with a clinical counselor and a family specialist. The training component has been expanded to include work-based learning for nurses and physicians.

This collaboration is expected to continue to reduce lengths of stay and medical complications, lead to fewer ICU transfers, and provide greater understanding of addiction and better patient perceptions among hospital medical staff.  It also lowers costs for the hospital and increased referrals for appropriate treatment at the addiction treatment provider.

The effort demonstrates that addiction treatment providers have a critical role in any linked network or accountable care organization.

Who to contact for more information

Raymond V. Tamasi, MEd, LCSW, LADC-I, Former President/CEO, Gosnold on Cape Cod

Margaret Q. Shapiro, RN, BSN, Former Clinical Educator, Falmouth Hospital