Implementation and Evaluation of an Emergency Department Medications for Opioid Use Disorder Program in a Regional Health System Without an Addiction Medicine Consult Service
Abstract
Background: Opioid overdose deaths in the United States have recently declined overall but remain high and are increasing among minority populations. Medications for opioid use disorder (MOUD) decrease mortality for patients with opioid use disorder (OUD) but are under prescribed nationwide.
Objective: We hypothesized that our health system's four community emergency departments (EDs), without an addiction medicine consult service, could safely implement an ED MOUD Quality Improvement Initiative to increase prescriptions for buprenorphine/naloxone, with a low rate of adverse events and without increasing opioid-related ED visits.
Methods: Retrospective case series of ED encounters, data were abstracted from the electronic health record (EHR) using EHR report with monthly manual chart audit for all ED patients coded with any of 127 ICD-10 opioid-related diagnostic codes. We identified visits for OUD in which patients were treated with buprenorphine (n = 95) at our four EDs from January to September 2023.
Results: In 9 months, there were 244 opioid-related encounters with 207 unique patients identified. Ninety-five of the 207 unique patients received a prescription for buprenorphine/naloxone. Of the 95 patients started on buprenorphine during an ED visit, 42 (44.2%) were engaged in treatment at 30 days. Adverse events were rare, with zero patients experiencing precipitated withdrawal or respiratory depression. Opioid-related ED visits did not increase; repeat ED visits by the…
How strong is the evidence?
Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health. Reported size: 207 participants or records.
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