Emergency Department Earns Award for Opioid Use Disorder Treatment and Named Finalist for COVID-19 Vaccine Initiative
The BMC group of ED pharmacists, physicians, and research assistants were delighted when both abstracts were selected as finalists for SAEM awards, and to learn that one, “Development and Implementation of an ED QI Initiative to Improve the Treatment of Patients with Opioid Use Disorder,” was ultimately awarded the SAEM Evidence-Based Healthcare & Implementation Interest Group’s Rakesh Engineer Award, a prestigious honor.
The group’s other abstract, “Implementation of an Emergency Department COVID-19 Vaccination Program at an Urban, Safety-Net Hospital,” was a finalist for the SAEM Research Award in the basic science category. To learn more about these initiatives and how they fit into the larger mission for health equity at BMC, HealthCity spoke with Natalija Farrell, PharmD, BCPS, DABAT, first author on both abstracts.
HealthCity: Congratulations! Can you tell us more about the initiatives these two abstracts were based on?
Natalija Farrell: Thank you, it’s quite an honor. I’ll start with our winning abstract about our work with opioid use disorder (OUD). At BMC, we're right at the center of the opioid epidemic. Our ED cares for a lot of patients following an opioid overdose, and has a patient population that, regardless of why they're arriving to the ED, has a high likelihood of substance use disorder. We wanted to find a way to incorporate harm reduction and OUD symptom recognition and treatment into their ED visit.
Historically, EDs in the US haven’t had a role in the recognition and treatment of opiate withdrawal with medications for OUD (MOUD)—such as methadone and buprenorphine. So, we started with targeted outreach to our ED providers, frontline nursing staff, and pharmacy staff about OUD, and provided education so they can recognize symptoms of OUD, and feel comfortable talking about the issue and providing treatment options. By making our teams more comfortable with the recognition of these disease states and the medications used to manage them, it's now become part of the standard care we provide in the ED. Because patients with OUD often come in for reasons unrelated to this disorder, it's hard for us to know what percentage of patients with OUD we're actually reaching. What we do know is that we're reaching more patients and making more referrals to outpatient addiction services than prior to implementing this new standard of care.
Regarding our COVID-19 initiative, we saw a need to provide the vaccine to high-risk adults, especially given that we serve populations without consistent access to the healthcare system. In May 2021, any unvaccinated pateints were asked by ED providers if they were interested in the vaccine and received some education about it. In July, the hospital assigned nurses to the ED to conduct the screening and give vaccines to patients. We found that about 46% of adult ED patients were eligible for the vaccine and regression analysis demonstrated that our ED-based vaccination efforts allowed us to vaccinate significantly more patients from communities disproportionately affected by COVID-19. Over five months, we vaccinated 417 individuals in the ED. Most of those vaccinated were from racial or ethnic minority groups, and despite many community programs vaccinating people experiencing homelessness, about 14% experienced unstable housing.
Even if patients weren't initially interested in the vaccine, the COVID-19 vaccination nurses spent time educating them, and as a result, some patients changed their minds. The ED managed to reach a lot more patients with the help of these nurses.
Our findings demonstrated that COVID-19 vaccination programs in the ED are feasible and succeed in reaching historically underserved populations.
HC: How did you come to develop these initiatives for the ED?
NF: For the OUD initiative, both Lauren Nentwich, MD, and I recognized that we had a large patient population with OUD that utilizes our ED services, and if we could make them feel comfortable during their ED stay, they would more likely engage in hearing about recovery options. That got the conversation rolling, and ultimately led to a much larger workgroup that included our addiction medicine colleagues.
For the COVID-19 vaccine, Elissa Schechter-Perkins, MD, MPH, our ED director of research and infectious disease, and I recognized that we have many patients using the ED for their primary care services. We knew many patients experienced inequities from the initial COVID-19 vaccination rollout because they do not have access to the large public vaccination sites. So, we worked together to gain buy-in from both pharmacy and the ED to move forward with offering vaccinations. Hospital leadership later provided dedicated resources, in the form of vaccination nurses, to help vaccinate even more ED patients.
HC: Do you see these initiatives as part of a larger goal to provide patients with add-on care while they are in the ED?
NF: Absolutely. Many of our patients don’t have primary care providers, so they utilize the ED in that type of capacity. It’s not the preferred way to provide this type of care, but we see the need to meet our patients where they're at. So, while they're here for their ED visit, we’re also looking at ways we can help optimize some of their other health care needs.
I think one of the reasons our COVID-19 vaccine program was so successful is because we have a history of providing other vaccines in the ED. For example, we provided a similar service for hepatitis vaccines when there was a hepatitis A breakout in 2018. And we also started providing influenza vaccinations in the ED a few years ago. The first year we vaccinated about 60 patients, and the numbers have grown every year. So now we have patients who ask, “While I'm here, can I also get my flu vaccine?” And we can do it for them instead of telling them they need to see their PCP. Having this foundation of care that we provide to our patients made it easier to offer the vaccine when COVID-19 came around, especially with our ED and our patients being so impacted by the virus. Not only was it a great service to our patients, but it also helped us because it had the downstream effect of having fewer COVID-positive patients coming into our ED.
HC: Are other EDs doing this type of work?
NF: It's hard to say exactly how many other EDs offer vaccination programs. Only one other hospital has published outcomes of their ED vaccination program during its first few weeks of implementation. At most of the conferences we've attended, there's been a lot of discussion about how to start a vaccination program in the ED, but it seems like most places haven’t yet implemented one. It seems that, by offering vaccinations in the ED, we are still in the minority.
HC: Why do you think this work is so important?
NF: I think it reflects BMC’s dedication to improving the care of patients who are disproportionately affected by various disease states, COVID-19 and OUD being just two of them. And with these initiatives, we're hoping to build trust within our patient population so when they are ready to seek help, they know that BMC is a safe place to turn for the services they need.