Capabilities Among Emergency Departments Participating in a Nationwide Quality Improvement Learning Collaborative to...

We sought to characterize changes in the proportion of key capabilities related to the emergency care of patients with opioid use disorder among emergency departments (EDs) participating in all years of the 2020 to 2024 the American College of Emergency Physicians Emergency Quality Network Opioid Initiative.

At the beginning of each annual quality improvement collaborative, EDs completed an online survey regarding capabilities on services for patients presenting to their ED with opioid use disorder or opioid overdose, including provision of outpatient naloxone after overdose, presence of a clinician who prescribes buprenorphine in the ED, an adopted protocol for buprenorphine initiation, and use of clinical support tools to guide opioid use disorder treatment.

A total of 174 unique EDs participated in all E-QUAL opioid collaboratives from 2020 to 2024. More than half of participating EDs were rural and saw less than 20,000 visits per year. EDs reported an increase in the naloxone provision to patients presenting after opioid overdose from 39.1% (68/174) in 2020 to 89.7% (156/174) in 2024. The number of EDs reporting a clinician who prescribes buprenorphine in their ED also increased (16.7% [29/174] in 2022 to 52.87% [92/174] in 2024). Protocols for ED-initiated buprenorphine and use of clinical support tools to guide the treatment of opioid use disorder remained similar (4.0% [7/174] to 5.8% [10/174] and 46.0% [80/174] to 48.9% [85/174]).

These trends demonstrate increasing acceptance and incorporation of naloxone provision after opioid overdose and ED clinicians who prescribe buprenorphine among a group of mostly rural, small community EDs participating in a quality improvement-based learning collaborative.