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The following is a summary of “Implementation of an Emergency Department Opioid Use Disorder Initiative: Clinical Processes and Institution Specific Education Improve Care,” published in the November 2024 issue of Emergency Medicine by Krumheuer et al. 

Emergency department (ED) visits and fatal overdoses associated with opioid use increased annually, while emergency clinician-initiated medication for opioid use disorder (MOUD) reduced mortality and improved treatment retention.  

Researchers conducted a retrospective study to describe and evaluate a program to implement MOUD at an academic ED using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework.  

They assessed individuals in the ED eligible for MOUD, over 1 year, a comprehensive MOUD program—including an electronic health record (EHR) order set, email updates, and resident training was implemented. Clinical processes, such as buprenorphine and naloxone use and referrals for outpatient treatment, were tracked and compared before and after the program rollout.  

The results showed that 319 eligible encounters were identified over the 2-year study period. The group primarily consisted of non-Hispanic white men, with an average age of 40 ± 12.8 years. Following the program’s launch, 57.7% (109/189) of individuals were offered or began buprenorphine treatment, compared to 35.4% (46/130) before (95% CI). The protocol-based dosing was applied in 92% of cases and referrals to outpatient treatment providers rose from 46.1% (60/130) to 63% (119/189; 95% CI). More individuals requested buprenorphine during the visit after the intervention (24.6% vs 10%).  

Investigators concluded the quality improvement program implemented with the RE-AIM framework led to increased buprenorphine prescriptions and outpatient treatment referrals at an academic ED. 

Source: jem-journal.com/article/S0736-4679(24)00340-8/abstract