A Multifaceted Health System Initiative For Screening And Intervention For Substance Use Disorders
Drug overdose deaths and the proportion attributed to opioids have increased sharply from 2020 to 2021. Medication for Opioid Use Disorder (MOUD), including methadone and buprenorphine, decrease overdose-related deaths. Prior work has focused on implementation of screening and initiation of treatment in emergency departments or inpatient initiation of buprenorphine. The purpose of this study is to determine whether, in an acute care setting, the implementation of universal screening for substance use disorders and provision of clinical decision support tools to initiate treatment for Opioid Use Disorder (OUD) leads to an increase in the number of patients started on treatment and connected to outpatient follow-up. Methods include implementation of nurse-led screening for all admitted patients and triggers to recommend intervention and referral to treatment for those who screen positive. An order set was also implemented with clinical decision support to guide initiation or continuation of MOUD. During the development of this project, our organization began efforts to address screening and treatment for all substance use disorders in the outpatient and emergency department settings as part of a NJ state quality of care initiative. We integrated our project into the broader health system-wide effort. Pilot results demonstrate feasibility of implementing universal screening in the emergency department, though fewer patients screened positive than expected. Further training of the nurses may be needed to accurately capture all individuals at risk. Results post-implementation of the order set demonstrate that more patients were discharged to home on buprenorphine and that the volume of consults to Addiction Medicine did not increase. Full implementation of the interventions will require ongoing assessment for accuracy of the screening results. Future plans include quantification of patient outcomes and workload.
Recommended CitationAplin, MD, FACP, Kara S., "A Multifaceted Health System Initiative For Screening And Intervention For Substance Use Disorders" (2022). Master of Science in Population Health Capstone Presentations. Presentation 27.