Patient Safety and Quality
Background: Opioid Use Disorder (OUD) related deaths have increased exponentially since 2000, with a record 72,000 deaths in 2017. The emergency department is the front line of health care’s response to this epidemic. New state and national laws seek to increase access to OUD treatment. Before implementing quality improvement changes, hospitals first need to quantify how well ED providers treat patients with OUD.
Methods: A retrospective analysis of patient charts from October 2018 was performed. Care was provided at an urban academic ED with annual volume of 135,000. Patients were identified by ICD coding of both primary diagnoses (n = 144, Defined as: ED visit directly related to OUD) and secondary diagnoses (n = 253, Defined as: ED visit for a complication of OUD or non-OUD related complaint). Charts were excluded for age <18, pregnancy, or dispositions of admission, against medical advice, or eloped. Charts were reviewed for resources provided: substance use counseling within 14 days, methadone or buprenorphine-naloxone administered in ED, buprenorphine-naloxone prescription given on discharge, naloxone-kit given at discharge.
Results: Primary OUD: 65% of patients received at least one OUD treatment resource. 60.4% had substance use counseling within 14 days (95%CI 52.3-68.0). 3.5% received buprenorphine-naloxone/methadone in ED (95%CI 1.5-7.9). 2.8% of patients had buprenorphine/methadone prescribed (95%CI 1.1-6.9). 4.8% of patients were given a naloxone-kit at discharge (95%CI 2.4-9.7).
Secondary OUD: 31% of patients received at least one OUD treatment resource. 21.7% of patients had substance use counseling within 14 days (95%CI 17.1-27.2). 1.9% received buprenorphine-naloxone/methadone in ED (95%CI 0.8-4.5). 3.5% of patients had buprenorphine-naloxone prescribed (95%CI 1.9-6.6). 0.7% of patients were given a naloxone-kit at discharge (95%CI 0.2-2.8).
Conclusion: In a large urban academic ED, a majority of patients presenting with a primary OUD diagnosis receive treatment. Secondary diagnosis OUD patients may receive treatment, but less than those above. There is opportunity for improvement in our care of both of these groups. MAT is not routinely performed in our ED. Identification of patients not receiving optimal OUD therapy is essential to addressing this epidemic.