Emergency Medical Services
Background: In order to streamline the ED referral process in a multi-network automated opioid treatment referral program, we performed a needs assessment of Medication for Opioid Use Disorder (MOUD) sites in the EMergency department-initiated BuprenorphinE for opioid use Disorder (EMBED) trial network.
Methods: Focus groups were conducted with four key stakeholders: 1) ED clinicians and staff (including addiction counselors), 2) community addiction treatment providers and staff, 3) health system IT specialists, and 4) medical ethics experts. Informed by the focus group findings, nineteen MOUD sites were surveyed to assess their ability to accept emergent patient referrals from the ED.
Results: Assessment of the stakeholders identified three goals to be incorporated into the referral system: 1) The system should be automated, flexible and allow multiple channels of referral, 2) Referral metrics are retrievable in a HIPPA compliant manner, 3) Patients are scheduled into MOUD sites as urgently as possible. Of the MOUD sites surveyed, 68.4% (13/19) responded. Based on the responses, specific patient identifiers were required for most MOUD site referrals. Encrypted emails and EHR were the preferred method of communication for the handoff. 53.8% (7/13) of the sites were able to accept patients within 3 days with only 1 site requiring longer than a week. Only 7.7% (1/13) facilities were able to accept weekend referrals as opposed to at least 69.2% (9/13) of facilities on Monday to Thursdays, and 46.2% (6/13) on Fridays. 92.3% (12/13) of the MOUD sites offer buprenorphine/naloxone and 38.4% (5/13) offer methadone.
Conclusion: The majority of MOUD sites surveyed are interested in facilitating ED referrals and willing to accommodate patients on an urgent basis. The availability of the MOUD sites varied with many accepting new patients on weekday mornings, Fridays excluded. Multiple patient identifiers were needed by most sites to initiate the referral process which may be in conflict with out-of-system referrals due to 42CFR part 2.