Improving hospital-based care for patients with injection-drug related infections: provider perspectives

Injection-related severe bacterial infections (SBIs), including skin and soft tissue infections, endocarditis, and osteomyelitis, are rising in prevalence in the United States and disproportionately affect people who inject drugs (PWID). Hospitalization for SBI presents a critical opportunity to engage patients in addiction and infectious disease care, yet healthcare systems often fail to capitalize on this moment. This qualitative study explores the perspectives of 22 clinical stakeholders, including physicians, surgeons, nurses, and social workers, on barriers and strategies to improve care for hospitalized people who inject drugs (PWID) with substance use disorders (SUDs). Participants were recruited through purposive sampling from a large urban healthcare institution and selected external sites. Semi-structured interviews were conducted and analyzed using a thematic analysis approach. Three core themes emerged: empowering clinical teams, enhancing patient care, and improving interdisciplinary workflows. Participants called for stronger provider education on substance use disorders, stigma reduction, and communication; expanded access to addiction consults, harm reduction tools, peer navigators, and flexible discharge options such as OPAT with coordinated follow-up. Barriers included limited staffing, inconsistent access to addiction specialists and peers, and institutional inertia around discharge and reimbursement. Stakeholders highlighted telemedicine and structured interdisciplinary communication as means to prevent care fragmentation, noting that patient-directed discharges often stem from unmanaged withdrawal, stigma, and mistrust within existing hospital systems. Our findings align with prior research on addiction consult models and highlight emerging support for hybrid care delivery models that integrate harm reduction, peer support, and telehealth. However, practical and structural limitations, such as policy constraints, funding gaps, and misaligned institutional incentives, remain significant obstacles. This study contributes to a growing body of literature calling for targeted, feasible interventions that can transform hospital-based care for PWID with SBIs. Future work should address patient perspectives and evaluate outcomes of proposed strategies to guide institutional investment and policy reform.