Auto-nudges increase emergency department treatment of opioid use disorder

A Penn Medicine study finds assessment for opioid withdrawal doubles when a triage screening question is paired with electronic health record automated prompts.

A program nudging emergency department clinicians to identify and treat opioid use disorder was found to double assessment for opioid withdrawal and increase initiation of evidence-based treatment, a new study from Penn’s Perelman School of Medicine showed.

A triage screening question to be asked by nurses was applied alongside an automated nudge in the electronic health record to increase clinicians’ awareness of patients with opioid use disorder and improve the likelihood patients would receive more comprehensive care in the emergency department. In addition to an observed increase in withdrawal assessments, the prompts were also associated with boosts in prescriptions for lifesaving medications used to treat opioid use disorder. The findings were published in Annals of Emergency Medicine.

Person in scrubs wheeling gurney into a hospital
Image: iStock/Sviatlana Lazarenka

“The big-picture context is that treatment with medications for opioid use disorder is highly effective, lowers mortality from overdoses by more than half, and doubles engagement with treatment after discharge from the emergency department,” says Margaret Lowenstein, an assistant professor of medicine, the research director of the Penn Center for Addiction Medicine and Policy (CAMP), and the study’s first author. “Our findings indicate that the screening and prompts help clinicians to recognize patients and increasingly initiate important care for them.”

The study built upon previous work by Lowenstein and senior author, M. Kit Delgado, an assistant professor of emergency medicine and director of the Penn Medicine Nudge Unit, which demonstrated that automation in the electronic health record alone was not sufficient for identifying opioid use disorder patients. Involving nurses on the front-end and consulting with patients in triage proved to be a vital step in the process.  

Historically, Lowenstein says, when patients with opioid use disorder came to emergency departments, they were typically discharged once their other urgent issues were managed. Patients would be given information on where to obtain treatment and many struggle to navigate the complicated substance use treatment system on their own.

But the emergency department is often the main, if not only, touchpoint many patients have with medical professionals. It is now increasingly recognized as a crucial opportunity to provide lifesaving care for many patients.

Lowenstein and Delgado’s latest study reveals findings from applying this process in three hospitals and comparing insights to two hospitals as controls for the study. The researchers found that the rates of patients with opioid use disorder who were identified and assessed for withdrawal climbed from a baseline of 26 to 48 percent after turning on the intervention. That boost coincided with a 12 percent increase in prescriptions for naloxone, the overdose-reversing nasal spray, and a 5 percent increase in prescriptions for buprenorphine, a medication that stabilizes opioid withdrawal, reduces cravings, and halves the risk of death among people with opioid use disorder.

Read more at Penn Medicine News.