The Journal of emergency medicine · 2024
Implementation of an Emergency Department Opioid Use Disorder Initiative: Clinical Processes and Institution Specific Education Improve Care.
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Krumheuer Aaron, Janke Alexander T, Nickel Alex, Kim Erin, Bailes Carrie, Ager Emily E, Purington Ella K, Mahmood Syed Mohammad, Hooyer Mitchell, Ryan Mary Loretta, Baker Jessica E, Purdy Megan, Greineder Colin F, Commissaris Carolyn V, Smith Shawna N, Fung Christopher M, Losman Eve D
Аннотация
BACKGROUND: Emergency department (ED) visits associated with opioid use and fatal overdoses increase annually. Emergency clinician-initiated medication for opioid use disorder (MOUD) reduces mortality and improves treatment retention.
OBJECTIVE: We describe and evaluate a program to implement MOUD at an academic ED using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework.
METHODS: This was a retrospective cohort study of patients presenting to the ED who were eligible for MOUD. A multipronged MOUD program consisting of electronic health record (EHR) order set, email communications, and resident education was delivered over 1 year. Clinical processes were measured before and after program implementation, including buprenorphine and naloxone utilization and outpatient referrals for treatment.
RESULTS: We identified 319 eligible encounters over the 2-year study period. Patients were predominantly non-Hispanic white men with a mean age of 40 ± 12.8 years. After program initiation, 109/189 patients (57.7%) were offered or initiated on buprenorphine, compared to 46/130 patients (35.4%) before (95% confidence interval). Protocol dosing was used in 92% of initiations. Outpatient treatment provider referrals increased from 46.1% (60/130) to 63% (119/189; 95% confidence interval). More patients in the postintervention group period requested buprenorphine during their visit compared to before the intervention (24.6% vs. 10%).
CONCLUSIONS: We observed improvements in the rate of buprenorphine prescription and outpatient treatment referrals at an academic ED following a quality improvement program implemented using the RE-AIM framework.
OBJECTIVE: We describe and evaluate a program to implement MOUD at an academic ED using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework.
METHODS: This was a retrospective cohort study of patients presenting to the ED who were eligible for MOUD. A multipronged MOUD program consisting of electronic health record (EHR) order set, email communications, and resident education was delivered over 1 year. Clinical processes were measured before and after program implementation, including buprenorphine and naloxone utilization and outpatient referrals for treatment.
RESULTS: We identified 319 eligible encounters over the 2-year study period. Patients were predominantly non-Hispanic white men with a mean age of 40 ± 12.8 years. After program initiation, 109/189 patients (57.7%) were offered or initiated on buprenorphine, compared to 46/130 patients (35.4%) before (95% confidence interval). Protocol dosing was used in 92% of initiations. Outpatient treatment provider referrals increased from 46.1% (60/130) to 63% (119/189; 95% confidence interval). More patients in the postintervention group period requested buprenorphine during their visit compared to before the intervention (24.6% vs. 10%).
CONCLUSIONS: We observed improvements in the rate of buprenorphine prescription and outpatient treatment referrals at an academic ED following a quality improvement program implemented using the RE-AIM framework.