Skip to main content Accessibility help
×
Home

Identification of emergency department patients for referral to rapid-access addiction services

  • Jessica Hann (a1) (a2) (a3), Howie Wu (a2), Aliyah Gauri (a1), Kathryn Dong (a1) (a2) (a4), Ni Lam (a1) (a2), Jeffrey A. Bakal (a5) and Allison Kirkham (a1) (a2)...

Abstract

Objectives

Substance-related emergency department (ED) visits are rapidly increasing. Despite this finding, many EDs do not have access to on-site addiction services. This study characterized substance-related ED presentations and assessed the ED health care team's perceived need for an on-site rapid-access addiction clinic for direct patient referral from the ED.

Methods

This prospectively enrolled cohort study was conducted at an urban tertiary care ED from June to August 2018. Adult ED patients with problematic or high-risk substance use were enrolled by ED staff using a one-page form. The electronic and paper records from the index ED visit were reviewed. The primary outcome evaluated whether the ED health care team would have referred the patient to an on-site rapid-access addiction clinic, if one were available.

Results

We received 557 enrolment forms and 458 were included in the analysis. Median age was 35 years, and 64% of included patients were male. Alcohol was the most commonly reported substance of problematic or high-risk use (60%). Previous ED visits within 7 days of the index visit were made by 28% of patients. The ED health care team indicated “Yes” for rapid-access addiction clinic referral from the ED for 66% of patients, with a mean of 4.3 patients referred per day during the study period.

Conclusions

At least four patients per day would have been referred to an on-site rapid-access addiction clinic from the ED, had one been available. This indicates a gap in care and collaborating with other sites that have successfully implemented this clinic model is an important next step.

RésuméObjectifs

Le nombre de consultations au service des urgences (SU) pour des troubles liés à l'utilisation de drogues connaît une augmentation rapide. Toutefois, bon nombre de SU ne disposent pas de service d'aide aux toxicomanes, sur place. L’étude visait donc à caractériser les consultations au SU motivées par des troubles liés à l'utilisation de drogues, et à évaluer la perception de l’équipe de soins au SU quant à la nécessité d'un service d'aide rapide aux toxicomanes, sur place, pour les patients provenant directement du SU.

Méthode

Il s'agit d'une étude de cohortes, prospective, menée dans un SU de soins tertiaires, en milieu urbain, de juin à août 2018. Les adultes examinés au SU et connaissant des problèmes ou des risques élevés de consommation de drogues ont été inscrits à l’étude par le personnel du SU, à l'aide d'un formulaire d'une page. Les dossiers électroniques et les dossiers sur papier concernant la visite de référence au SU ont fait l'objet d'examen. Le principal critère consistait en l’évaluation du personnel du SU quant à la pertinence d'orienter des patients vers un service d'aide rapide aux toxicomanes, sur place, s'il y en avait eu un.

Résultats

L’équipe a reçu 557 formulaires d'inscription, et 458 patients ont été inclus dans l’étude. L’âge médian s’élevait à 35 ans, et 64% des sujets retenus étaient des hommes. D'après le formulaire d'inscription, la drogue causant le plus de problèmes ou associée le plus souvent à une consommation risquée (60%) était l'alcool. Par ailleurs, 28% des patients étaient déjà allés au SU, au cours des 7 jours précédant la consultation de référence. Dans 66% des cas, l’équipe de soins au SU a indiqué « Oui » quant à la nécessité de diriger des patients vers un service d'aide rapide aux toxicomanes; ainsi, 4,3 patients par jour, en moyenne, auraient été orientés vers ce type de soutien, durant la période à l’étude.

Conclusion

Au moins 4 patients par jour, provenant directement du SU, auraient été dirigés vers un service d'aide rapide aux toxicomanes, sur place, s'il y en avait eu un. Les résultats font ressortir une lacune dans la prestation des soins, et la collaboration avec des centres qui ont déjà réussi à mettre sur pied ce genre de service clinique représente une étape importante.

Copyright

Corresponding author

Correspondence to: Dr. Jessica Hann, 2J2.00 WC Mackenzie Health Sciences Centre, 8440 112 St NW, Edmonton, Alberta, T6G 2R3, Canada; Email: jehann@ualberta.ca

References

Hide All
1.Alberta Government [Internet]. Opioid and substances of misuse: Alberta Report 2017 Q4; March 2, 2018; [about 28 screens]. Available at: https://open.alberta.ca/publications/opioids-and-substances-of-misuse-alberta-report (accessed October 31, 2019).
2.Alberta Government [Internet]. Opioid and substances of misuse: Alberta Report 2018 Q4; March 2019; [about 37 screens]. Available at: https://open.alberta.ca/publications/opioids-and-substances-of-misuse-alberta-report (accessed October 31, 2019).
3.Government of Canada [Internet]. Overview of national data on opioid-related harms and deaths; December 12, 2018; [about 1 screen]. Available at: https://www.canada.ca/en/health-canada/services/substance-use/problemativ-prescription-drug-use/opioids/data-surveillance-research/harms-deaths.html (accessed October 31, 2019).
4.Canadian Institute for Health Information [Internet]. Hospitalizations and emergency department visits due to opioid poisoning in Canada; 2016; [about 31 screens]. Available at: https://secure.cihi.ca/free_products/Opioid%20Poisoning%20Report%20%20EN.pdf (accessed October 31, 2019).
5.Young, L. Opioids death toll in Canada nearly 4,000 last year, new data show. Canadian Broadcasting Company [Internet]. June 19, 2018; Life: [about 3 screens]. Available at: https://www.cbc.ca/news/politics/opioid-death-toll-marketing-1.4712419 (accessed October 31, 2019).
6.National Safety Council [Internet]. Injury facts: all injuries; 2017; [about 2 screens]. Available at: https://injuryfacts.nsc.org/all-injuries/overview (accessed October 31, 2019).
7.Fowler, K, Senthilingam, M. Odds of dying from accidental opioid overdose in the US surpass those of dying in car accident. Cable News Network [Internet]. January 14, 2019; Life: [about 1 screen]. Available at: https://www.cnn.com/2019/01/14/health/opioid-deaths-united-states-surpass-road-accidents/index.html (accessed October 31, 2019).
8.Centre for Disease Control [Internet]. CDC's efforts to prevent opioid overdoses and other opioid-related harms; January 2019; [about 2 screens]. Available at: https://www.cdc.gov/opioids/pdf/Strategic-Framework-Factsheet_Jan2019_508.pdf (accessed October 31, 2019).
9.Kendall, CE, Boucher, LM, Mark, AE, et al. A cohort study examining emergency department visits and hospital admissions among people who use drugs in Ottawa, Canada. Harm Reduction J 2017;14(1):16.
10.Brubacher, JR, Mabie, A, Ngo, M, et al. Substance-related problems in patients visiting an urban Canadian emergency department. CJEM 2008;10(3):198204.
11.Martin, A, Mitchell, A, Wakeman, S, White, B, Raja, A.Emergency department treatment of opioid addiction: an opportunity to lead. Acad Emerg Med 2018;25(5):601–4.
12.Morris, DW, Ghose, S, Williams, E, Brown, K, Khan, F.Evaluating psychiatric readmissions in the emergency department of a large public hospital. Neuropsychiatr Dis Treat 2018;14:671–9.
13.Elliott, K, Klein J, W, Basu, A, Sabbatini, AK.Transitional care clinics for follow-up and primary care linkage for patients discharged from the ED. Am J Emerg Med 2016;34(7):1230–5.
14.Breton, AR, Taira, DA, Burns, E, O'Leary, J, Chung, RS.Follow-up services after an emergency department visit for substance abuse. Am J Manag Care 2007;13(9):497505.
15.Weiner, SG, Baker, O, Bemson, D, Schuur, JD.One-year mortality of opioid overdose victims who received naloxone by emergency medical services. Ann Emerg Med 2017;70(4S) (Abstract).
16.Andrews, CM, Westlake, M, Wooten, N.Availability of outpatient addiction treatment and use of emergency department services among Medicaid enrollees. Psychiatr Serv 2018;69(6):729–32.
17.Pecoraro, A, Horton, T, Ewen, E, et al. Early data from Project Engage: a program to identify and transition medically hospitalized patients into addictions treatment. Addict Sci Clin Pract 2012;7:20.
18.O'Toole, TP, Pollini, RA, Ford, DE, Bigelow, G.The effect of integrated medical-substance abuse treatment during an acute illness on subsequent health services utilization. Med Care 2007;45(11):1110–5.
19.Friedmann, PD, Hendrickson, JC, Gerstein, DR, Zhang, Z, Stein, MD.Do mechanisms that link addiction treatment patients to primary care influence subsequent utilization of emergency and hospital care? Med Care 2006;44(1):815.
20.Palepu, A, Horton, NJ, Tibbetts, N, Dukes, K, Meli, S, Samet, JH.Substance abuse treatment and emergency department utilization among a cohort of HIV-infected persons with alcohol problems. J Subst Abuse Treat 2003;25(1):3742.
21.Englander, H, Weimer, M, Solotaroff, R, et al. Planning and designing the Improving Addiction Care Team (IMPACT) for hospitalized adults with substance use disorder. J Hosp Med 2017;12(5):339–42.
22.Beveridge, R, Clarke, B, Janes, L, et al. Canadian Emergency Department Triage and Acuity Scale: implementation guidelines. Can J Emerg Med 1999;1(3 Suppl):S2-S28.
23.Otterstatter, MC, Crabtree, A, Dobrer, S, et al. Patterns of health care utilization among people who overdosed from illegal drugs: a descriptive analysis using the BC Provincial Overdose Cohort. Health Promot Chronic Dis Prev Can 2018;38(9):328–33.
24Urbanoski, K, Cheng, J, Rehm, J, Kurdyak, P.Frequent use of emergency departments for mental and substance use disorders. Emerg Med J 2018;35(4):220–5.
25.Howard, R, Fry, S, Chan, A, Ryan, B, Bonomo, Y.A feasible model for early intervention for high-risk substance use in the emergency department setting. Aust Health Rev 2019;43(2):188–93.
26.Blow, FC, Walton, MA, Barry, KL, et al. Alcohol and drug use among patients presenting to an inner-city emergency department: a latent class analysis. Addict Behav 2011;36(8):793800.
27.Zhang, L, Norena, M, Gadermann, A, et al. Concurrent disorders and health care utilization among homeless and vulnerably housed persons in Canada. J Dual Diagn 2018;14(1):2131.
28.Hensel, JM, Taylor, VH, Fung, K, Yang, R, Vigod, SN.Acute care use for ambulatory care-sensitive conditions in high-cost users of medical care with mental illness and addictions. Can J Psychiatry 2018, doi: 10.1177/0706743717752880.

Keywords

Type Description Title
PDF
Supplementary materials

Hann et al. supplementary material
Hann et al. supplementary material

 PDF (65 KB)
65 KB

Identification of emergency department patients for referral to rapid-access addiction services

  • Jessica Hann (a1) (a2) (a3), Howie Wu (a2), Aliyah Gauri (a1), Kathryn Dong (a1) (a2) (a4), Ni Lam (a1) (a2), Jeffrey A. Bakal (a5) and Allison Kirkham (a1) (a2)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed