Medical College of Wisconsin, Department of Emergency Medicine, Division of Medical Toxicology, Milwaukee, Wisconsin.
University of Colorado School of Medicine, Aurora, Colorado.
West J Emerg Med. 2024 Jul;25(4):483-489. doi: 10.5811/westjem.18019.
We sought to describe emergency department (ED) buprenorphine treatment variability among EDs with varying operational characteristics.
We performed a retrospective cohort study of adult patients with opioid use disorder discharged from 12 hospital-based EDs within a large healthcare system as a secondary data analysis of a quality improvement study. Primary outcome of interest was buprenorphine treatment rate. We described treatment rates between EDs, categorized by tertile of operational characteristics including annual census, hospital and intensive care unit (ICU) admission rates, ED length of stay (LOS), and boarding time. Secondary outcomes were ED LOS and 30-day return rates.
There were 7,469 unique ED encounters for patients with opioid use disorder between January 2020-May 2021, of whom 759 (10.2%) were treated with buprenorphine. Buprenorphine treatment rates were higher in larger EDs and those with higher hospital and ICU admission rates. Emergency department LOS and 30-day ED return rate did not have consistent associations with buprenorphine treatment.
Rates of treatment with ED buprenorphine vary according to the operational characteristics of department. We did not observe a consistent negative relationship between buprenorphine treatment and operational metrics, as many feared. Additional funding and targeted resource allocation should be prioritized by departmental leaders to improve access to this evidence-based and life-saving intervention.
我们旨在描述具有不同运营特征的急诊科之间的急诊部丁丙诺啡治疗变异性。
我们对从大型医疗保健系统内的 12 家医院急诊科出院的成年阿片类药物使用障碍患者进行了回顾性队列研究，这是一项质量改进研究的二次数据分析。主要观察结果是丁丙诺啡治疗率。我们根据年度普查、医院和重症监护病房 (ICU) 入院率、急诊科住院时间 (LOS) 和住院时间等运营特征的三分位数对急诊科之间的治疗率进行了描述。次要结果是急诊科 LOS 和 30 天返回率。
在 2020 年 1 月至 2021 年 5 月期间，有 7469 名患有阿片类药物使用障碍的患者在急诊科就诊，其中 759 名 (10.2%) 接受了丁丙诺啡治疗。较大的急诊科和具有较高医院和 ICU 入院率的急诊科丁丙诺啡治疗率更高。急诊科 LOS 和 30 天内急诊科返回率与丁丙诺啡治疗没有一致的关联。
根据急诊科的运营特点，接受急诊科丁丙诺啡治疗的比例存在差异。我们没有观察到丁丙诺啡治疗与运营指标之间一致的负相关关系，正如许多人所担心的那样。部门领导应优先考虑额外的资金和有针对性的资源分配，以改善获得这种基于证据和拯救生命的干预措施的机会。
