Variability in Practice of Buprenorphine Treatment by Emergency Department Operational Characteristics

TL;DR

This study examines how emergency departments with different operational characteristics vary in their use of buprenorphine to treat opioid use disorder.

Contribution

The study identifies that larger emergency departments and those with higher admission rates are more likely to use buprenorphine, challenging prior concerns about operational impacts.

Findings

Buprenorphine treatment rates were higher in larger emergency departments and those with higher hospital and ICU admission rates.

Emergency department length of stay and 30-day return rates did not consistently correlate with buprenorphine treatment rates.

The study suggests that operational concerns about buprenorphine use may be overstated.

Abstract

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.