How to Lower Inpatient Dropout Rates

"I would be interested in more discussion about how to lower the dropout rate in an inpatient substance abuse treatment program.”

It’s a complex issue but here are a few observations.

Improving completion rates is largely a matter of:

1) Figuring out why people are dropping out and then

2) Taking logical steps to correct it.

Each situation is different, but the following is generally true.

First, there’s usually more than one problem. Picture a boat with two holes in its bottom. Fix one and not the other and the second leaks a little worse than before. You have to look at multiple possible factors.

Second: It could well be that certain employees are part of the problem. Not just clinicians, either. Many other staff interact with patients and can contribute (usually unwittingly) to a dropout problem.

A common error is to take corrective action before you clearly understand what’s wrong. Better to do the necessary research and assessment before attempting a fix. This’ll save you wasted time and energy, and you won’t inadvertently make things worse.

One important question is when (during the course of treatment) you have the most dropouts. Shortly after admission, or during detox, or after detox meds stop? A bit later on in treatment or a few days before scheduled discharge? Or any combination of the above.

You can look at variables such as your staffing pattern, your activity schedule, your volunteers (if you have them), the day of the week or the shift where most dropouts occur… and so forth.

You can look at such data on a quarterly basis. Use your CQI or Performance Improvement Committee to drill down and provide feedback.

Some of the steps you take will ultimately be interventional, designed to correct problems. Others will be preventive in nature — designed to keep a potential problem area from escalating into a full-fledged catastrophe.