ABSTRACT
Background: To enhance dissemination of resources promoting evidence-based care of emergency department (ED) patients with opioid use disorder (OUD) and assess practices related to OUD care in EDs with a range of characteristics and resources, we developed the ACEP Emergency Medicine Quality Network (E-QUAL) Opioid Initiative. This national ED-focused practice-based learning network seeks to increase provision of naloxone and medication for the treatment of OUD (MOUD) by supporting local quality improvement (QI) through a curated toolkit with webinars and resources, a QI chart review to assess and benchmark ED care, and the dissemination of best practices. Method(s): In March of 2021, participating EDs were requested to complete a structured chart review of 30 randomly selected ED visits between September 2020 - February 2021 (baseline) with ICD-10 codes for opioid overdose or OUD, and to report on the following measures: substance use evaluation in the ED, naloxone offer/provision, MOUD administration (methadone or buprenorphine) in the ED, buprenorphine prescription at discharge, documented overdose prevention or harm reduction provision, and referral to OUD treatment. In November 2021, EDs were requested to review and submit metrics from an additional 30 charts for visits between July 2021- October 2021 (follow-up). Descriptive statistics and student's t tests were used to evaluate differences. Result(s): Among the 385 EDs participating in the 2021 E-QUAL Opioid Initiative learning collaborative, the median annual ED visit volume for adults was 14,552, with 138 (36%) classified as rural and 43 (11%) as critical access. Chart review data were submitted for 4,877 ED visits during the baseline period and 5,629 visits during follow-up. Between the baseline and follow-up periods, documented substance use evaluation in the ED increased from 89% to 93% (p<0.001) and OUD referral rate increased from 63% to 84% (p<0.001). Overall, the discussion or provision of naloxone (34% to 27%;p<0.001) and the documentation of overdose prevention and harm reduction counseling (67% to 60%;p<0.001) decreased across the two time points, although among the subset of patients with opioid overdose, naloxone discussion/provision increased (36% to 43%;p<0.001). Provision of buprenorphine and methadone in the ED (1% to 4%;p<0.001) and provision of an outpatient prescription of buprenorphine (2% to 3%;p<0.05) increased as well. Conclusion(s): EDs participating in a national practice-based learning network demonstrated improvement in several measures of ED OUD care. This study represents the first feasibility assessment of collection of measures from a nationwide sample including rural and community EDs for this purpose. Although improvements are modest, improved rates of OUD evaluation, treatment referral and MOUD treatment provision after participation in an online learning collaborative amidst the COVID-19 pandemic demonstrate the importance and potential for ongoing education and quality improvement. Yes, authors have interests to disclose Disclosure: Foundation for Opioid Response (FORE) Foundation Grant Support Foundation for Opioid Response (FORE) Foundation Copyright © 2022