Implementation of an Emergency Department Opioid Use Disorder Initiative: Clinical Processes and Institution Specific Education Improve Care.

Authors

Aaron Krumheuer
Alexander T Janke
Alex Nickel, Corewell Health East Resident
Erin Kim
Carrie Bailes
Emily E Ager
Ella K Purington
Syed Mohammad Mahmood
Mitchell Hooyer
Mary Loretta Ryan

Document Type

Article

Publication Date

4-2025

Publication Title

The Journal of emergency medicine

Abstract

BACKGROUND: Emergency department (ED) visits associated with opioid use and fatal overdoses increase annually. Emergency clinician-initiated medication for opioid use disorder (MOUD) reduces mortality and improves treatment retention.

OBJECTIVE: We describe and evaluate a program to implement MOUD at an academic ED using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework.

METHODS: This was a retrospective cohort study of patients presenting to the ED who were eligible for MOUD. A multipronged MOUD program consisting of electronic health record (EHR) order set, email communications, and resident education was delivered over 1 year. Clinical processes were measured before and after program implementation, including buprenorphine and naloxone utilization and outpatient referrals for treatment.

RESULTS: We identified 319 eligible encounters over the 2-year study period. Patients were predominantly non-Hispanic white men with a mean age of 40 ± 12.8 years. After program initiation, 109/189 patients (57.7%) were offered or initiated on buprenorphine, compared to 46/130 patients (35.4%) before (95% confidence interval). Protocol dosing was used in 92% of initiations. Outpatient treatment provider referrals increased from 46.1% (60/130) to 63% (119/189; 95% confidence interval). More patients in the postintervention group period requested buprenorphine during their visit compared to before the intervention (24.6% vs. 10%).

CONCLUSIONS: We observed improvements in the rate of buprenorphine prescription and outpatient treatment referrals at an academic ED following a quality improvement program implemented using the RE-AIM framework.

Volume

71

First Page

104

Last Page

113

Recommended Citation

Krumheuer A, Janke AT, Nickel A, Kim E, Bailes C, Ager EE et al Implementation of an emergency department opioid use disorder initiative: clinical processes and institution specific education improve care. J Emerg Med. 2025 Apr;71:104-113. doi: 10.1016/j.jemermed.2024.10.009. PMID: 39988494.

DOI

10.1016/j.jemermed.2024

ISSN

0736-4679

PubMed ID

39988494