A joint initiative between the Departments of Medicine and Psychiatry, the First Step Day Program provides comprehensive healthcare for patients with substance use disorders being discharged from the Johns Hopkins Hospital inpatient services. The Program consists of both a medical service and a psychiatric service, and operates 12 hours a day (7am to 7pm), seven days a week. The weekend medicine consult fellow is only responsible for the medical service patients. First Step Medicine has capacity for 8-9 patients and usually runs at or near that volume.
Typically patients on First Step Medicine are completing a course of antibiotics for endocarditis, osteomyelitis, are receiving skilled-level wound care and opioids for pain, or require frequent nursing care for some other complicated medical condition. Additionally, about 40-50% of the patients are HIV positive, many with very low CD4 counts.
All the patients are in some phase of recovery from substance abuse, including acute detoxification from opioids or alcohol, opioid dependence treatment with either methadone or sublingual buprenorphine, and active participation in a recovery program that includes both individual and group counseling. At night, patients are transported to gender-specific, off-site supervised housing facilities, although there occasionally are patients who come from home.
While the acuity level of the patients may not always appear noticeable or severe, this is a population that requires a higher than expected level of care compared with more traditional outpatients. Given the multitude and variety of health needs that the patients have, it is essential that they receive on-going medical supervision and care, even on the weekends. To that end, the weekend coverage provided by the fellows is critical and very much appreciated.
