The following is a summary of “Impact of Universal Screening and Automated Clinical Decision Support for the Treatment of Opioid Use Disorder in Emergency Departments: A Difference-in-Differences Analysis,” published in the August 2023 issue of Emergency Medicine by Lowenstein et al.

The initiation of buprenorphine in the emergency department (ED) has been shown to enhance outcomes in individuals with opioid use disorder. However, the level of acceptance and implementation of this practice varies significantly. Researchers have introduced a nurse-led triage screening inquiry to minimize variability in the electronic health record system to detect individuals with opioid use disorder. This is followed by specific prompts within the electronic health record to assess withdrawal symptoms and guide subsequent actions in patient care, such as initiating treatment. They aimed to evaluate the effects of screening implementation in three urban academic emergency departments. A quasi-experimental study was conducted to examine opioid use disorder-related emergency department visits. Electronic health record data from January 2020 to June 2022 was utilized. 

The triage protocol was implemented in three emergency departments (EDs) from March to July 2021, while two other EDs within the health system were designated as control groups. Investigators assessed modifications in therapeutic interventions over time. They employed a difference-in-differences analysis to compare the results in the three intervention emergency departments with those in the two control groups. About 2,462 medical consultations were recorded in the intervention hospitals, with 1,258 talks occurring during the pre-period and 1,204 consultations during the post-period. The control hospitals had 731 consultations, with 459 consultations pre-period and 272 consultations post-period.

The patient characteristics observed in the intervention and control emergency departments (EDs) remained consistent throughout the designated periods. In comparison to the control hospitals, the triage protocol exhibited a 17% higher augmentation in withdrawal assessment, as measured by the Clinical Opioid Withdrawal Scale (COWS) (95% CI 7 to 27). Buprenorphine prescriptions upon discharge exhibited a 5% increase (95% CI: 0% to 10%), while naloxone prescriptions demonstrated a 12% increase (95% CI: 1% to 22%) in the intervention emergency departments compared to the control group. A triage screening and treatment protocol implemented in the emergency department resulted in heightened evaluation and management of opioid use disorder. Medical protocols specifically developed to establish screening and treatment as the standard practice show potential in enhancing the adoption of evidence-based care for individuals with opioid use disorder in the emergency department.

Source: sciencedirect.com/science/article/pii/S0196064423002652