An Emergency Department Nudge-Based Strategy to Screen and Treat Patients With Alcohol Misuse

Area of Science:

• Emergency Medicine
• Addiction Medicine
• Health Services Research

Background:

• Alcohol misuse is a significant public health issue with high rates of emergency department (ED) visits.
• Initiation of evidence-based treatment, such as naltrexone, in the ED can improve patient outcomes.
• Current ED practices often lack systematic approaches to identify and treat alcohol misuse.

Purpose of the Study:

• To evaluate a multicomponent strategy for increasing the initiation of evidence-based alcohol misuse treatment in the ED.
• To assess the effectiveness and implementation of a protocol integrating screening, electronic health record (EHR) decision support, and treatment facilitation.

Main Methods:

• A quasi-experimental design was used across 6 hospitals, with 4 intervention EDs and 2 control EDs.
• Interventions included an ED discharge order set with clinical decision support and patient screening for alcohol concerns.
• Multivariate logistic regression and difference-in-difference analyses compared naltrexone prescribing rates before and after interventions.

Main Results:

• The study identified 8,909 patients with alcohol-related diagnoses over 43 months.
• Naltrexone prescribing increased from 0.2% at baseline to 3.2% in phase 2 at intervention hospitals.
• Intervention hospitals showed a significantly greater absolute increase in naltrexone prescribing (2.9%) compared to control hospitals.

Conclusions:

• A triage-based ED protocol integrating screening, EHR alerts, and clinical decision support effectively increased naltrexone initiation for alcohol misuse.
• This multicomponent strategy demonstrates a successful approach to improving the management of alcohol use disorder in the emergency department setting.