Evaluation of low-intensity initiatives to improve linkage to care for emergency department patients with opioid use disorder

Objectives: Emergency departments (EDs) frequently encounter patientswith opioid use disorder (OUD) not engaged in substance use treatment.We report the effectiveness of two low-resource interventions used to refer ED patients to treatment. Methods: This is a retrospective program evaluation of two referral interventions in an urban, academic ED. In phase 1, emergency physicians referred patients to a community-based referral hotline. Phase 2 had two stages, 1) addition of an electronic referral to our addiction clinic, and 2) electronic health record (EHR) alert identifying patients with indications of OUD prompting use of the electronic referral. Primary outcomes included number of hotline referrals, electronic referrals, and patients attending treatment appointment. Secondarily, we report number of EHR alerts. Outcomes are reported as numbers and proportions with 95% confidence intervals (CIs). Results: In phase 1, hotline referrals occurred for 12 of the 1,310 (0.9%, 95% CI 0.5- 1.6) ED encounters estimated to have an indicator of OUD. In phase 2, physicians electronically referred 64 of the 1,395 (4.6%, 95% CI 3.6-5.9) encounters estimated to have an indicator of OUD (before alert) and 164 of the 1,395 (11.8%, 95% CI 10.1- 13.6) encounters with an alert. Of the 228 total electronic referrals, five (2.2%) attended treatment appointment. During EHR alert operation, 1,395/19,072 ED encounters (7.3%, 95% CI 7.0-7.7) had an alert fire. Conclusion: Addition of a hotline, electronic referral, and EHR alertwereminimally impactfulmethods for linking ED patients with OUD to treatment, demonstrating the need for more resource intensive measures to improve linkage referral.