Multi-site intervention to improve emergency department care for patients who live with opioid use disorder: A quantitative evaluation

Abstract

Background Opioid use disorder is a major public health crisis, and evidence suggests ways of better serving patients who live with opioid use disorder in the emergency department (ED). A multi-disciplinary team developed a quality improvement project to implement this evidence. Methods The intervention was developed by an expert working group consisting of specialists and stakeholders. The group set goals of increasing prescribing of buprenorphine/naloxone and providing next day walk-in referrals to opioid use disorder treatment clinics. From May to September 2018, three Alberta ED sites and three opioid use disorder treatment clinics worked together to trial the intervention. We used administrative data to track the number of ED visits where patients were given buprenorphine/naloxone. Monthly ED prescribing rates before and after the intervention were considered and compared with eight nonintervention sites. We considered whether patients continued to fill opioid agonist treatment prescriptions at 30, 60, and 90 days after their index ED visit to measure continuity in treatment. Results The intervention sites increased their prescribing of buprenorphine/naloxone during the intervention period and prescribed more buprenorphine/naloxone than the controls. Thirty-five of 47 patients (74.4%) discharged from the ED with buprenorphine/naloxone continued to fill opioid agonist treatment prescriptions 30 days and 60 days after their index ED visit. Thirty-four patients (72.3%) filled prescriptions at 90 days. Conclusions Emergency clinicians can effectively initiate patients on buprenorphine/naloxone when supports for this standardized evidence-based care are in place within their practice setting and timely follow-up in community is available.

Buprenorphine–naloxone practice and attitudes in 22 Canadian emergency physician groups: a cross-sectional survey

“…Although many studies have reported on ED-specific or region-based BUP programs, 17,[19][20][21][22] few studies have reported the practice patterns of individual ED physicians. Compared with a 2018 survey that found 7% of Canadian ED physicians prescribed BUP often or always, 28 a greater proportion of our respondents reported prescribing BUP once a month or more.…”

Opioid Use Disorder Treatment Disruptions during the COVID-19 Pandemic and Other Disasters: A Scoping Review Addressing Dual Public Health Emergencies

“…At the system level, Alberta's Strategic Clinical Networks are mandated to address cross-systems issues with evidence-based solutions in collaboration with diverse stakeholders, to support data-driven decision making, improve population health and catalyze health equity (34). For instance, the Emergency Strategic Clinical Network built referral pathways between s emergency departments and addiction treatment clinics prior to the pandemic (35). At a provincial level, systems can embrace harm reduction and contextually tailored care with decriminalization of people who use substances (15,36) and clinical guidelines for safe supply (25) that systemically addresses stigma.…”

Recommendations for Emergency Departments Caring for Persons with Opioid Use and Opioid Use Disorders: An Integrative Review

“…Retrospective studies relied on documentation of OUD in the medical record. 16,21,23 Opioid Withdrawal…”

“…Nine studies in which buprenorphine was administered in the emergency department measured symptom severity via the Clinical Opiate Withdrawal Scale (COWS). 11,16,17,21,[23][24][25][26] COWS cut scores for buprenorphine induction ranged from > _5 24,25 to a score of > _36 corresponding to severe opioid withdrawal. 11…”