Problem:
Waiting for urinalysis test results delays first methadone dose.
Solution:
Use a “Quick-strip” or instant in-house STAT urine test to reduce waiting time for urinalysis results.
Featured Stories
Seven Hills Behavioral Health Services Methadone Treatment Facility in New Bedford, Massachusetts, reduced the waiting time until first methadone dose from 12 days to 6 days. They streamlined the urine testing process by using a Quick-strip UA instead of sending UAs to an outside lab. If test results come back “clean,” they schedule the Initial Clinical Assessment (ICA) and follow that with titration. If test results come back “dirty,” they are able to recognize the problem sooner and let the client know that they need to come in and do another one, which speeds up the admission process. Clients are much more satisfied with the Quick-strip UAs because they don’t have to wait as long, and staff are happier with the increased efficiency. The impact on budget was minimal. They obtain the Quick-strips from their lab, Clinical Science.
Brandywine Counseling, Inc., in Wilmington, Delaware was able to offer same day intake and first medication by replacing external lab testing with instant STAT urine tests. Urine test results were essential because clients must be negative for benzodiazepines before methadone can be administered. In addition to offering instant urine tests, they (1) reviewed policies and procedures to determine what revisions needed to be made to allow same day intake and first medication, (2) created an orientation video for clients to view on the day of intake, replacing a group orientation that had previously been offered only twice weekly, and (3) prepared the doctors, nurses, intake counselors, and other affected staff for the changes involved in same day treatment. To reduce stress and address any issues that arose during this change, the team held 10-minute intake staff debriefings at the end of each day. Within one month, these changes reduced the waiting time between intake and first methadone treatment for individuals seeking admission to the opioid treatment program from 2.3 days to 8 hours.
Lessons Learned
- Reducing the waiting time reduced the opportunity for opiate-addicted clients to seek drugs and lose motivation for treatment.
- Reducing the waiting time for medication increases continuation in treatment and increased revenue associated with further services.
- Positive word of mouth about the experience in the community increased the census.
- Quick-strips or quick cups are available from most labs.
Tracking Measures
Cycle Measures
Number of days between getting urine sample and test results.
Data Collection Form
None
ActionSteps
Plan
- 1. Collect baseline data on number of days between getting urine sample and test results.
- 2. Decide which urine test to use.
Do
- 1. Use new urine test with selected clients.
Study
- 1. Check the fidelity of the change. Was it implemented as planned?
- 2. Track the number of days between getting urine sample and test results.
- 3. Evaluate the change.
- Did the time between getting the urine sample and getting results decrease?
- Did the time between first contact and first methadone dose decrease?
- Was the new urine test easy to administer?
Act
- 1. Streamline the process for using the quick urine test and re-test this promising practice for an additional two weeks.
Repeat this series of steps until you have a process for instant urine tests in place for all clients who need it.