241 Are Emergency Department Patients Started on Medications for Opioid Use Disorder When Admitted?

Abstract

Emergency departments (EDs) across the country are improving care for patients with opioid use disorder (OUD) by initiating buprenorphine in the ED. However, less is known about buprenorphine initiation when patients with OUD are identified in the ED and then admitted to inpatient services. We aim to determine the percentage of patients started on medication OUD (MOUD) that were identified in the ED and subsequently admitted to an inpatient service. Secondary objectives were to compare the rate of subsequent ED visits or admissions between groups receiving MOUD and those not receiving MOUD during their index admission. This retrospective, observational study examined patients presenting to our urban, academic ED between 3/1/18 and 12/31/20. Patients identified with OUD during their ED visit who met with a peer recovery specialist (PRS) but were not started on buprenorphine due to plan for admission were eligible for inclusion. A chart review was performed, and the variables extracted included if MOUD was initiated during the inpatient admission, and if the patient had any subsequent ED or inpatient admissions between the index visit and 1/15/21. The percentage of admitted patients started on MOUD was determined, and treated and untreated patients were then compared by whether they had 1 or more ED visits, and 1 or more inpatient admissions using Fisher’s exact test; comparisons were also performed for numbers of ED-visits, psychiatric and non-psychiatric admissions using the Wilcoxon signed-rank test. Of the 43 patients who met inclusion criteria, 63% were admitted to inpatient psychiatry, 28% to general internal medicine, and 9% to another inpatient service. Across all services, 67% of patients were not started on MOUD, 23% were started on buprenorphine, and 9% on naltrexone. The majority of patients (67%) were not given a prescription for naloxone at discharge, and 37% did not have a documented referral or appointment for addiction treatment at discharge. Although trends were seen, there were no statistically significant differences found in rates of subsequent ED visits and hospitalizations between the MOUD-treated and untreated groups. The MOUD-treated group was somewhat less likely than the untreated group to have one or more ED visits (57% vs. 69%, p=0.51) or non- psychiatric hospital (0% vs. 24%, p=.077), and fairly equal rates of admission to the psychiatric hospital (29% vs. 24%, p=.75). When groups were compared in terms of counts of ED visits, psychiatric or non-psychiatric admissions, there were again no statistically significant differences (p=0.49, 0.98, and 0.076, respectively). A minority of patients identified to have OUD by the ED were started on MOUD if admitted at the index ED visit. There is a promising trend of decreased subsequent ED and inpatient utilization for those started on MOUD from this cohort; however, it is not statistically significant likely due to small sample size. Improved workflows between EDs and inpatient services, and improved strategies for initiating MOUD on inpatients units may increase access to MOUD.