Speaker
Edward R Melnick, MD, MHS
Associate Professor of Emergency Medicine, Yale School of Medicine
Associate Professor of Biostatistics (Health Informatics), Yale School of Public Health
Program Director, Yale-VA Clinical Informatics Fellowship Program
Gail D’Onofrio, MD, MS
Albert E. Kent Professor of Emergency Medicine
Yale School of Medicine
Professor of Public Health, Chronic Disease & Epidemiology
Yale School of Public Health
Keywords
EMBED; Opioid use disorder; Buprenorphine; EHR workflow
Key Points
- The epidemic of opioid misuse continues to escalate with almost 70 thousand deaths attributed to prescription and illicit opioids in 2020.
- Medications for opioid use disorder, including Buprenorphine, are available and can be prescribed to patients in the emergency department, but less than 30% of patients who are eligible for BUP receive the medication. Buprenorphine/naloxone (BUP) is safe, effective, decreases withdrawal, and decreases opioid overdose events.
- EMBED was started to address the barriers and promote the facilitators to initiating BUP in the emergency department. Common barriers included complex protocols, knowledge gaps, and poor usability of health IT systems. Promoting a proper learning tool was a helpful facilitator for initiating BUP.
- EMBED was an 18-month pragmatic, parallel, group randomized trial conducted in 18 emergency department clusters in 5 healthcare systems.
- EMBED created a user centered design to simplify the clinician’s role in initiating BUP to an automatic 5-minute process that included diagnosing opioid use disorder, assessing withdrawal severity, motivating patients to accept treatment, and an automatic EHR workflow for prescribing and referral.
- EMBED increased Naloxone prescriptions at discharge for intervention patients (18.6%) compared with control patients (6.0%). Of the patients eligible, BUP was initiated using EMBED for 42.5%. Physicians in the intervention group initiated BUP (39.7%) and prescribed naloxone (52.1%) at a higher rate than physicians in the control group (initiated BUP 30.1%; prescribed naloxone, 27.4%).
- EMBED increased provider adoption of complex, unfamiliar evidence-based practices in the emergency department. EMBED can help improve consistency and quality of care for patients with opioid use disorder.
Discussion Themes
– Gentle nudges to encourage clinicians to use the health IT, may increase use. Incentives to use the health IT may also lead to greater use.
– The explosion of health information, especially with regard to emergency department care, has increased acceptance of the use of health IT pathways that give the most updated evidence for care.
Learn more about the EMBED project and read about the findings from EMBED.
Tags
#pctGR, @Collaboratory1