Reasons for emergency department visits of patients with opioid use disorder at an urban safety-net hospital: A retrospective records review.

OBJECTIVES: The purpose of this study was to describe the emergency department (ED) visit chief complaints and discharge diagnoses of patients with an opioid use disorder (OUD) empaneled to a primary care clinic. DESIGN: ED visits were retrospectively reviewed through electronic health records. Patients with a history of using multiple substances and medical or psychiatric conditions were compared to those without these conditions. SETTING: This study was conducted at Harbor-UCLA ED, a safety-net level one trauma center. PATIENTS AND PARTICIPANTS: Eligible participants were empaneled to the Harbor-UCLA Family Health Center with a diagnosis of OUD between January 1, 2018, and December 31, 2020. MAIN OUTCOME MEASURES: The primary outcome measures included number of ED visits, hospital admissions, chief complaints, and discharge diagnoses. RESULTS: The total number of patients was 59. The most common chief complaints were musculoskeletal (34 percent), gastrointestinal (18 percent), general (13 percent), and skin (8.6 percent). The most common discharge diagnoses were musculoskeletal (27 percent), gastrointestinal (20 percent), infectious (11 percent), substance use disorder related (11 percent), psychiatric (7 percent), and cardiovascular (7 percent). Co-occurring alcohol use was associated with a higher number of visits, 3.18 versus 1.15 (p = 0.021), and a higher percentage of patients with frequent visits, 46 percent versus 8 percent (p = 0.008). Patients with diabetes had more frequent visits, 40 percent versus 10 percent (p = 0.036), and were more likely to be admitted, 43 percent versus 15 percent (p = 0.010). CONCLUSIONS: This study highlights the importance of screening and the management of alcohol use and diabetes among patients with OUD.

Providing Low-barrier Addiction Treatment Via a Telemedicine Consultation Service During the COVID-19 Pandemic in Los Angeles, County: An Assessment 1 Year Later.

BACKGROUND: Los Angeles County Department of Health Services provides medical care to a diverse group of patients residing in underresourced communities. To improve patients' access to addiction medications during the COVID-19 pandemic, Los Angeles County Department of Health Services established a low-barrier telephone service for DHS providers in March 2020, staffed by DATA-2000-waivered providers experienced with prescribing addiction medications. This study describes the patient population and medications prescribed through this service during its initial 12 months. METHODS: We performed a retrospective evaluation of a provider-entered call registry for the telephone consult line. Information was collected between March 31, 2020, and March 30, 2021. The registry includes information related to patient demographics, the reason for visit, and which addiction medications were prescribed. We conducted descriptive statistics in each of these domains. RESULTS: During the study period, 11 providers on the MAT telephone service logged 713 calls. These calls represented a total of 557 unique patients (mean age of 40 years, 75% male, 41% Latino, 49% experiencing homelessness). Most patients either had Medicaid insurance (77%) or were uninsured (20%). The most prescribed addiction medication was buprenorphine-naloxone (90%), followed by nicotine replacement therapy (5.3%), naltrexone (4.2%), and buprenorphine monotherapy (1.8%). CONCLUSION: A telephone addiction medication service is feasible to deliver low-barrier medications to treat addiction in underresourced communities, especially to individuals experiencing homelessness. This can mitigate but does not eliminate disparities in access to addiction medications for communities of color.

Applying international organization for standards 9001 to create an effective surgical quality committee.

BACKGROUND: Efforts to improve surgical safety are limited by several factors and no consensus exists regarding the most effective way to improve surgical quality. The use of ISO 9001 quality standards within healthcare is recognized but has not been widely applied for improving surgical outcomes. METHODS: A surgical quality committee was created using ISO 9001:2015 standards. Quality objectives were assessed to understand how any suggested changes will be impacted due to risks and opportunities inherent in the system. RESULTS: The initial quality focus was on surgical site infections in 5 services. Change in surgical infection ratio from 2018 to 2019 showed significant improvement: coronary bypass 1.288 vs. 0.901; Colon 1.359 vs. 0.589; Hysterectomy 2.119 vs. 1.022; Knee 1.391 vs. 0.306; Hip 0 vs. 0.302. CONCLUSIONS: This is one of the first studies using ISO 9001 to improve surgical quality. The results indicate both acceptance and success of applying continual improvement strategies.