Peers in Acute Care Settings Help Achieve Clinical and Administrative Goals

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Peers in Acute Care Settings Help Achieve Clinical and Administrative Goals

Hospital administrators face great pressure to enhance quality metrics and patient outcomes while managing costs. Peer services offer an evidence-based solution that delivers measurable improvements in clinical care, discharge planning effectiveness, and healthcare utilization.

What are Peers?

Peers are individuals with shared experience, such as substance use or mental health history, to the patients they serve. That shared experience helps them empathize, understand, and build rapport with patients. In the healthcare workforce, the title Peer may refer to Certified Peer Specialists or other positions that are optimized by lived experience, such as Peer Care Navigators, which may or may not require certification. 

Administrative and Operational Benefits

Peer integration delivers tangible returns on investment through improved clinical outcomes, reduced healthcare burden, and enhanced operational efficiency. These benefits directly support key administrative priorities and quality improvement initiatives. 

Benefits to Healthcare Systems and Quality Metrics

  1. Reduced readmissions and acute care utilization1, 2, 3
    • One multicenter study of over 10,000 ED patients showed a significant reduction in ED utilization: from 83% to 50%, and a decrease in overdose-related hospital events from 7% to 4% in the six months following a peer-led intervention. 4 
    •  Another study found a 44% decrease in hospitalizations and a 9% decrease in ED visits in the six months following peer engagement.5
  2. Decreased opioid overdoses
    •  One large-scale study using Medicaid data from 70 hospitals found that peer implementation was associated with 8.6% reduction in repeat medically treated overdoses.6
  3. Increased initiation of Medications for Opioid Use Disorder (MOUD)
    • A study of over 3,000 hospitalized patients with OUD found a 60.8% rate of successful outcomes (initiation of MOUD, referral, or treatment appointment) in those with peer engagement, versus 17.1% for those who did not.
    • Patients who saw peers were also more likely to receive MOUD while admitted: 26.9%, versus 6.7% for those who did not.7
  4. Improved linkage, engagement and retention in substance use disorder treatment.8, 9, 10
  5. Increased patient satisfaction scores through positive perceptions of care11
  6. Positive culture change across healthcare systems12, 13, 14, 15

Benefits for Clinical Teams

  1. Improved communication, trust, and shared decision-making between patient and care team.16
    • In one study, over one third (38.9%) of peer-patient interactions resulted in sharing new information with the health care team.17
  2. Support for overwhelmed clinical staff during high-volume periods, including with communication, discharge planning, and conflict de-escalation.
  3. Model patient-centered interactions
  4. Correct myths and decrease stigma of mental health and substance use disorders

Benefits for Patients

  1. Better treatment outcomes, with increased initiation of medications for opioid use disorder (MOUD) and reduced substance use18, 19
  2. Increased hopefulness and activation for recovery20
  3. Comprehensive support including goal setting, discharge preparation, care advocacy, medical information translation, self-help education

The Role of Peers

Peers draw on their lived experience to connect with patients, building credibility and trust. This can break down barriers to effective engagement. Peers support patients by:

  • Being a trusted communication source and advocate
  • Translating medical information
  • Providing self-help education and resources
  • Supporting goal identification and recovery planning during key periods of motivation
  • Sharing personal recovery stories to build connection and inspire hope17

A peer workflow in acute care includes identifying patients (e.g., through EHR consults, track board flags), screening, motivational interviewing, coordination with nurses for discharge planning, and post-discharge follow-up. ED encounters are brief and focused on immediate needs and rapid discharge planning, while inpatient settings allow for extended engagement with daily bedside visits and more intensive transition planning over the course of the hospital stay.

Implementation 

Peer programs can be funded through reimbursement mechanisms when peers are employed by behavioral health agencies. Key implementation steps include partnering with behavioral health agencies and establishing clear role definitions and reporting structures. Comprehensive implementation guidance is available through the resources below.

Resources

  1. Washington State Department of Health

    1. Peer Support Specialist Certification Information
  2. Washington State Health Care Authority (HCA)
    1. Operationalizing Peer Support OPS program offers state-specific implementation and ongoing operational support with technical assistance, training, monthly webinars, and weekly office hours.
    2. Service Encounter Reporting Instructions (SERI) provides billing and reimbursement information.
  3. National Implementation Support
    1. NACCHO Emergency Department-Based Substance Use Response Toolkit - ED-specific implementation guide
    2. SAMHSA Peer Support Workers Technical Assistance - Training videos and evidence-based practice materials
    3. PeerTAC Supervision Guide - Comprehensive peer supervision guidance
    4. Philadelphia Peer Support Toolkit - Interactive implementation tools

References

  • Randall MG, Horn BP, Crisanti AS. The Economic Effect of Peer Recovery Support Services: A Review of the Literature. Community Ment Health J. 2024;60(4):826-831. doi:10.1007/s10597-023-01212-z

  • Eddie D, Hoffman L, Vilsaint C, et al. Lived Experience in New Models of Care for Substance Use Disorder: A Systematic Review of Peer Recovery Support Services and Recovery Coaching. Front Psychol. 2019;10:1052. Published 2019 Jun 13. doi:10.3389/fpsyg.2019.01052

  • Lukacs T, Klein L, Bramante R, Logiudice J, Raio CC. Peer recovery coaches and emergency department utilization in patients with substance use disorders. Am J Emerg Med. 2023;69:39-43. doi:10.1016/j.ajem.2023.03.039

  • Nordeck CD, Oros M, Raley H, Smith S, Gryczynski J. Changes in hospital utilization following peer-led intervention for substance use disorders in hospital emergency departments. Am J Emerg Med. Published online May 28, 2025. doi:10.1016/j.ajem.2025.05.049

  • Magidson JF, Regan S, Powell E, et al. Peer recovery coaches in general medical settings: Changes in utilization, treatment engagement, and opioid use. J Subst Abuse Treat. 2021;122:108248. doi:10.1016/j.jsat.2020.108248

  • Treitler P, Crystal S, Cantor J, et al. Emergency Department Peer Support Program and Patient Outcomes After Opioid Overdose. JAMA Netw Open. 2024;7(3):e243614. Published 2024 Mar 4. doi:10.1001/jamanetworkopen.2024.3614

  • Tager A, Calderwood L, Crews C, Murphy A, Bowe A, Nazha H. Identifying factors associated with peer recovery coach interactions and successful outcomes for patients with opioid use disorder in Southern West Virginia. Am J Addict. Published online June 8, 2025. doi:10.1111/ajad.70052

  • Reuter QR, Santos AD, McKinnon J, Gothard D, Jouriles N, Seaberg D. Long-term treatment retention of an emergency department initiated medication for opioid use disorder program. Am J Emerg Med. 2022;55:98-102. doi:10.1016/j.ajem.2022.02.041

  • Jennings LK, Lane S, McCauley J, et al. Retention in Treatment after Emergency Department-Initiated Buprenorphine. J Emerg Med. 2021;61(3):211-221. doi:10.1016/j.jemermed.2021.04.007

  • Tracy K, Burton M, Nich C, Rounsaville B. Utilizing peer mentorship to engage high recidivism substance-abusing patients in treatment. Am J Drug Alcohol Abuse. 2011;37(6):525-531. doi:10.3109/00952990.2011.600385

  • Collins D, Alla J, Nicolaidis C, et al. "If It Wasn't for Him, I Wouldn't Have Talked to Them": Qualitative Study of Addiction Peer Mentorship in the Hospital. J Gen Intern Med. Published online December 12, 2019. doi:10.1007/s11606-019-05311-0

  • Stack E, Hildebran C, Leichtling G, et al. Peer Recovery Support Services Across the Continuum: In Community, Hospital, Corrections, and Treatment and Recovery Agency Settings - A Narrative Review. J Addict Med. 2022;16(1):93-100. doi:10.1097/ADM.0000000000000810

  • Chen Y, Yuan Y, Reed BG. Experiences of peer work in drug use service settings: A systematic review of qualitative evidence. Int J Drug Policy. 2023;120:104182. doi:10.1016/j.drugpo.2023.104182

  • Cooper RE, Saunders KRK, Greenburgh A, et al. The effectiveness, implementation, and experiences of peer support approaches for mental health: a systematic umbrella review. BMC Med. 2024;22(1):72. Published 2024 Feb 29. doi:10.1186/s12916-024-03260-y

  • Byrne L, Roennfeldt H, Wolf J, et al. Effective Peer Employment Within Multidisciplinary Organizations: Model for Best Practice. Adm Policy Ment Health. 2022;49(2):283-297. doi:10.1007/s10488-021-01162-2

  • Bédard K, Boisvert I, Rochette M, Racine E, Martel-Laferrière V. Exploring the value and acceptability of a patient navigator program for people who inject drugs and are hospitalized for bacterial infections: patients', community organization and healthcare workers' perspectives. BMC Infect Dis. 2025;25(1):221. Published 2025 Feb 14. doi:10.1186/s12879-025-10617-y

  • O'Neill M, Michalski C, Hayman K, et al. "Whatever journey you want to take, I'll support you through": a mixed methods evaluation of a peer worker program in the hospital emergency department. BMC Health Serv Res. 2024;24(1):147. Published 2024 Jan 30. doi:10.1186/s12913-023-10532-5

  • Gertner AK, Roberts KE, Bowen G, Pearson BL, Jordan R. Universal screening for substance use by Peer Support Specialists in the Emergency Department is a pathway to buprenorphine treatment. Addict Behav Rep. 2021;14:100378. Published 2021 Sep 25. doi:10.1016/j.abrep.2021.100378

  • Reif S, Braude L, Lyman DR, et al. Peer Recovery Support for Individuals With Substance Use Disorders: Assessing the Evidence. Psychiatric services (Washington, DC). 2014;65(7):853-861. doi:10.1176/appi.ps.201400047

  • Austin EE, Cheek C, Richardson L, et al. Improving emergency department care for adults presenting with mental illness: a systematic review of strategies and their impact on outcomes, experience, and performance. Front Psychiatry. 2024;15:1368129. Published 2024 Feb 29. doi:10.3389/fpsyt.2024.1368129

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