For patients living with substance use disorder, the Emergency Department (ED) is a critical point of intervention as they may be at higher risk of mortality once discharged. As reported in a 2021 study published in the Canadian Medical Association Journal, more than half of persons in BC with an overdose had visited the ER in the previous year. While an estimated 60,000 British Columbians had a substance use disorder in 2021, the signs are not always clear and can be missed in a busy emergency room.
Dr. Andrew Kestler
Dr. Andrew Kestler, Advancing Health scientist, Regional Emergency Department Substance Use Lead, and emergency physician at UBC and St. Paul’s Hospital, is leveraging technology as part of the opioid crisis response. He spearheaded a project to introduce alerts in the electronic health record system (CST Cerner) that flag signs of opioid use. Based on predefined criteria, the alerts launch based on key indicators such as if a patient had a previous hospital visit for opioid intoxication. An alert could also appear if the patient previously received a medication used to treat opioid use disorder (e.g. Methadone or Buprenorphine/Naloxone, also known as Suboxone).
Following a pilot launched in April 2021 to a select number of St. Paul’s Hospital physicians, Dr. Kestler worked with CST project partners to optimize the Opioid alerts. Since June 7, these have been available in EDs at St. Paul’s Hospital, Mount Saint Joseph Hospital and Vancouver General Hospital. Now accompanied by an electronic decision support guide, the alerts prompt physicians to screen for active substance use, and, if applicable, offer interventions. This may include referrals to outreach teams or addiction medicine services, among other supports.
“It’s too early to gauge the impact Opioid alerts will have for patient outcomes,” said Dr. Kestler. “However, even a small, incremental change could have an impact when you consider the magnitude of the crisis.”
“The screening process has always been challenging for substance use disorder. Asking about substance use at triage (when the patient checks in) does not necessarily work well for the patient or the care team. This is a measure to have the electronic health record system help do the work for us.”
Recently, a broad suite of tools were rolled out to PHC and VCH emergency departments to ensure better continuity of care. The same technology has potential benefits for patients living with substance use disorder. Many do not have a fixed address and rely on emergency department medical services as their main point of contact with the health care system. It’s also not uncommon for patients to leave the ED before receiving treatment, which can put them at even higher risk. Now notified upon registration if a patient has left another ED site, care teams are better equipped to close the gap. Overall, these tools support a more holistic approach to harm reduction and treatment for substance use disorder in the face of this province-wide public health emergency.
This story originally appeared on PHC News
