Improving care for patients with alcohol use disorder through a large-scale regional emergency department quality improvement initiative.

OBJECTIVES

Alcohol use disorder is a significant risk to public health. This initiative's primary aim was to develop and implement a standardized regional approach for emergency physician initiation of pharmacotherapy for alcohol use disorder in adults across 28 emergency departments within Interior Health.

METHODS

The intervention was implemented across 28 EDs in the Interior Health region of British Columbia, Canada. The approach was embedded in culturally safe and trauma-informed care and included structured screening during the secondary nursing assessment, brief interventions with motivational interviewing, withdrawal management and medication for alcohol use disorder initiation, and timely referrals to community-based addiction services, including a regional virtual addiction medicine clinic. The intervention followed a phased implementation strategy, incorporating tailored education sessions for ED staff and ongoing support to ensure adaptation to local contexts and workflows.

RESULTS

By June 2024, 197 patients were enrolled; 56% (111/197) filled a prescription, 40% (45/111) refilled at 30 days, and 25% (28/111) continued treatment at 90 days. Surveys had < 10% response rates: among 22 patient respondents, 64% rated care "good/very good," and provider awareness among respondents increased from 24 to 47% after education.

CONCLUSIONS

The initiative has demonstrated substantial progress in addressing critical gaps in the care of individuals with alcohol use disorder within EDs in the Interior Health region by enhancing early intervention and follow-up. Key successes include the integration of nurse-led screening, pharmacotherapy initiation, and enhanced referral pathways to addiction services. This model of care offers a scalable framework for other regions and healthcare systems to adopt, demonstrating the potential for broader systemic change in addiction care.