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. 2022 Jan 1;3(1):10.1056/CAT.21.0297.
doi: 10.1056/CAT.21.0297.

Redesign of Opioid Use Disorder Screening and Treatment in the ED

Margaret Lowenstein  1   2 , Rachel McFadden  3 , Dina Abdel-Rahman  4 , Jeanmarie Perrone  5   2   6   7 , Zachary F Meisel  2   8 , Nicole O'Donnell  9 , Christian Wood  10 , Gabrielle Solomon  11 , Rinad Beidas  2   12   13   14 , M Kit Delgado  2   15   16   17
Affiliations

Redesign of Opioid Use Disorder Screening and Treatment in the ED

Margaret Lowenstein et al. NEJM Catal Innov Care Deliv. .

Abstract

Traditionally, patients with opioid use disorder (OUD) seen in EDs have been medically cleared, discharged, and left to navigate a complex treatment system after discharge. Replacing this system of care requires reimagining the ED visit to promote best practices, including starting treatment with lifesaving medications for OUD in the ED. In this article, the authors present stakeholder-informed design of strategies for implementation of evidence-based ED OUD care at Penn Medicine. They used a participatory design approach to incorporate insights from diverse clinician groups in an iterative fashion to develop new processes of care that identified patients early to initiate OUD care pathways. Their design process led to the development of a nurse-driven protocol with OUD screening in ED triage coupled with automated prompts to both nurses and physicians or advanced practice providers to perform assessment and treatment of OUD and to deliver evidence-based treatment interventions.

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Conflict of interest statement

Disclosures: Margaret Lowenstein, Rachel McFadden, Dina Abdel-Rahman, Jeanmarie Perrone, Zachary Meisel, Nicole O’Donnell, Christian Wood, Gabrielle Solomon, Rinad Beidas, and M. Kit Delgado have nothing to disclose.

Figures

FIGURE 1
FIGURE 1
ED Screening Workflow
FIGURE 2
FIGURE 2
Opioid Use Triage Screen
FIGURE 3
FIGURE 3
Best Practice Alert
FIGURE 4
FIGURE 4
Banner
FIGURE 5
FIGURE 5
Characteristics of Patients Completing Screening
FIGURE 6
FIGURE 6. Patients Identified Through Screening
The vertical dashed line represents the first month of screening, March 2021. The blue line demonstrates the increased number of patients identified by screening compared with diagnosis codes alone (the red line). Screening led to a net increase of 0.5% in patients identified relative to using diagnosis codes alone. While there was an initial large increase in the rate of positive screening and then a flattening, we saw a similar trend in those identified with diagnosis codes alone, consistent with the variability in ED presentation rate over time. OUD 5 opioid use disorder.
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References

    1. Centers for Disease Control and Prevention. Increase in Fatal Drug Overdoses Across the United States Driven by Synthetic Opioids Before and During the COVID-19 Pandemic. December 17, 2020. Accessed October 29, 2021. https://emergency.cdc.gov/han/2020/han00438.asp.
    1. Rosenbaum J, Lucas N, Zandrow G, et al. Impact of a shelter-in-place order during the COVID-19 pandemic on the incidence of opioid overdoses. Am J Emerg Med 2021;41:51–4 https://www.sciencedirect.com/science/article/pii/S0735675720311645?via%... https://doi.org/10.1016/j.ajem.2020.12.047. - DOI - PMC - PubMed
    1. Appa A, Rodda LN, Cawley C, et al. Drug overdose deaths before and after shelter-in-place orders during the COVID-19 pandemic in San Francisco. JAMA Netw Open 2021;4:e2110452 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2779782 https://doi.org/10.1001/jamanetworkopen.2021.10452. - DOI - PMC - PubMed
    1. Mattick RP, Breen C, Kimber J, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev 2014; (2):CD002207 https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD002207.pub4/... https://doi.org/10.1002/14651858.CD002207.pub4. - DOI - DOI - PMC - PubMed
    1. Mancher M, Leshner AI, eds. Medications for Opioid Use Disorder Save Lives. Washington, DC: The National Academies Press, 2019. https://www.ncbi.nlm.nih.gov/books/NBK538936/. - PubMed