Unveiling hidden connections: How social networks impact diversion in hospital emergency departments: An exploratory social network analysis

Due to a lack of safeguards, controlled substances (CS) can be diverted (stolen) from healthcare facilities. While it is known that healthcare workers (HCWs) can use their social networks within the medication use process (MUP) to facilitate diversion, the specific connections between HCWs and the MUP tasks most vulnerable to diversion remain poorly understood. Social network analysis (SNA) was used to analyze social connections to identify influential relationships between HCWs and tasks susceptible to diversion.To map the social network structures of MUP tasks vulnerable to CS diversion in two Emergency Departments (EDs), identify influential tasks and HCWs, and report HCW perceptions of in-hospital diversion.This study used a mixed methods approach in the ED of two large hospitals in Toronto, Canada. Previously collected clinical observation data was used to identify tasks at risk of diversion, and cross-sectional surveys were conducted to assess HCW's involvement in the identified vulnerable tasks. A two-mode SNA was conducted to identify connections between HCWs and tasks susceptible to drug diversion.SNA identified a circular structure across both sites, highlighting the network's redundancy and capacity to efficiently disseminate information. Nurses were central to tasks with a higher risk of diversion. Physicians and Pharmacists had limited direct involvement in these tasks. Tasks with frequent interprofessional interactions, such as creating, following, or reviewing orders for non-admitted patients, are vulnerable to diversion due to HCWs acting on decisions made by other professionals without closely scrutinizing the details. No significant differences were observed between sites, suggesting a shared perception of diversion. The SNA results highlight the critical role of network structure in shaping vulnerability to diversion. The similarities across both sites suggest a systemic challenge across ED settings that require targeted interventions. By uncovering critical points of influence, we can better understand how diversion occurs and develop targeted interventions to prevent it.