More Emergency Room Efforts Needed to Identify Opioid Overdose Risks
A substantial portion of emergency department patients are at risk for opioid overdose, and efforts should be made to identify those with opioid-related diagnoses to offer them naloxone kits and other interventions, School of Public Health and Medicine researchers say in a new report.
Writing in Public Health Reports, the research team conducted a review of emergency department (ED) visits at a Boston hospital and used diagnosis codes to place patients into three risk categories: those who experienced opioid overdoses or poisoning; those with opioid dependence or misuse; and those who were prescribed opioids during their ED visit. Of the more than 96,000 patients who visited the ED during the two-year study period, 19.3 percent met the criteria for at least one risk category, the analysis showed. Patients in the two highest-risk categories were more likely to be non-Hispanic white and male, compared with all ED patients.
The authors said the use of diagnostic codes is a promising approach to identifying patients with opioid-related problems. In a companion paper in BMC Research Notes, the same research team found that a policy implemented at a large urban hospital in Boston in 2013 to offer naloxone rescue kits and overdose prevention and response education to patients in the ED at risk for opioid overdose was hampered, in part, by a “lack of consensus” on who should be given the overdose-reversing medication. That paper also cited logistical and workflow problems.
“Clearly defining the target population for overdose prevention efforts is necessary for successful integration within the ED setting, and doing so must appropriately balance prioritization of the population most at risk, while reaching the greatest number of those at risk,” the authors said.
They said the use of risk categories, defined by ICD-9-CM discharge codes, “may facilitate prioritization of the distribution of naloxone rescue kits, and could be supported by an electronic medical record alert for clinicians working with patients who are potentially at risk for overdose.”
The research team said the ED is an important venue for intervening in opioid misuse and called for additional study to determine how best to use the risk-classification system to guide overdose-prevention efforts.
Both studies were conducted by a team than included: Mari-Lynn Drainoni, associate professor of health law, policy & management; Edward Bernstein, professor of community health sciences and of emergency medicine at MED; Elisa Koppelman, project director of health law, policy & management; Jacqueline Ellison, a PhD student in health services research at SPH; Alexander Walley, associate professor at MED; James Feldman, professor at MED; and Patricia Mitchell, research assistant professor at MED.