Overdose Measures Matter

Indicator Profile

Percent of emergency departments (EDs) with dedicated staff who assist people with substance use disorder (SUD), such as by providing SUD assessments, harm reduction services and linkage-to-care services

Category: Linkage to Care

Audience: Convener

Data Type: Quantitative

Indicator Overview

Description:

Percent of emergency department (EDs) with dedicated staff who assist people with substance use disorder (SUD), such as by providing SUD assessments, harm reduction services and linkage-to-care services.

Rationale:

Emergency departments often serve as the first point of access to healthcare for many people, particularly for people with urgent medical needs and those without regular access to medical care. As such, EDs can be a primary entry point into care for people who have experienced a nonfatal drug overdose or struggle with SUD. In fact, EDs frequently see patients who have experienced non-fatal overdoses,1,2 providing a critical opportunity to intervene and connect people to treatment and support services.3

Staff working in EDs can screen patients for SUD and provide patients with access to medications for opioid use disorder (MOUD), harm reduction services and a warm handoff to a longer-term care provider and other needed care. Having dedicated staff to assist people with SUDs can help ensure that patients receive timely and appropriate care and are connected to vital resources to support their health and well-being.

Related Indicators:

Consider pairing this indicator with the number of peer navigators embedded into community settings working to connect people to care and services. This can provide greater insight into the number and types of settings—beyond emergency departments—that have staff dedicated to serve the needs of people with SUD.

In addition, tracking the number or percent of referrals to care and services, can help determine how many referrals originate from emergency departments, compared to other service settings. This can shed light on the types of settings that are most accessible to clients as well as the types of services that are in greatest demand.

Indicator Details

Definitions:

Emergency departments (EDs), or emergency rooms, are defined as a hospital-based facilities that provide 24-hour emergency care to patients who need urgent medical attention. EDs provide unscheduled patient services (i.e., services people who don’t have an appointment) including rapid assessment, stabilization and treatment for acute illnesses, injuries or life-threatening conditions.

Dedicated staff who assist people with SUD include all paid personnel, such as doctors, nurses, social workers, counselors and peer navigators, who are specifically trained to address the needs of individuals with SUD, work in the ED and focus on providing specialized care to patients with SUD. Staff may be employed by the ED or may be from outside organizations but are embedded within the ED.

Specialized care may include but is not limited to providing SUD screening and assessments, providing harm reduction services, prescribing MOUD, coordinating resources, case management and connecting patients to appropriate treatment, care and other needed services.

Numerator and Denominator:

Numerator: Number of EDs with dedicated staff who assist people with SUD, within jurisdiction

Denominator: Total number of EDs within jurisdiction

Note: Select the jurisdiction that is most relevant to your assessment needs. Your jurisdiction could be your county, region, district or even state.

Ways to Examine the Data:

  1. Type of staff by training/role (e.g., nurse, social worker, counselor or peer navigator); by internal (i.e., employed by ED facility) vs external status (i.e., employed by other organization but embedded within ED)
  2. Types of services provided
  3. Region or hospital catchment area

Data Sources:

  • ED staff
  • ED partner organization staff

Data Collection Methods:

  • Surveys to ED staff
  • Interviews with ED staff
  • Surveys to organizations that embed dedicated SUD staff within EDs
  • Review electronic medical record (EMR) database for ED staffing information

Note: Contact hospital administration to determine the best way to collect this information

Application and Considerations

Suggested Use:

  • To identify gaps in resources for people with SUD who access EDs
  • To assess how the availability of dedicated staff to interact with people with SUD in the ED setting
  • To identify opportunities to build linkage to care (referral) networks

Health Access Considerations:

You may want to consider:

  • How many dedicated staff are embedded within each ED per shift? Are they able to meet the needs of patients who are admitted to the ED? Does this vary by shift?
  • What type of staff are embedded within each ED? Are they nurses, social workers or peer navigators? What types of services or care are they able to provide?
  • What type of staff seem to be most effective in either providing or linking to services?
  • What types of services or care are staff actually providing? What types of services or care are they currently unable to provide that are being requested by patients?
  • What are the demographics of embedded staff (e.g., sex, race, age)? How are they similar or different to the patient population?
  • What are the primary language(s) of patients admitted to the ED? How does this align with the language(s) spoken by embedded staff?
  • How does the pay and benefits for these positions compare to similar jobs?

Evaluation Considerations:

Limitations:

  • Does not address the quality of services available
  • Does not address barriers related to receiving care and services
  • Does not assess how care and services are being offered to patients
  • Does not assess which patients are offered care and services (e.g., Are these services offered to all patients or only when indicated? Is there a protocol?)
  • Does not assess whether offers for care or services were accepted or utilized

Policy Considerations and Resources:

Additional Resources

Examples:

  • Anderson, E. S., Rusoja, E., Luftig, J., Ullal, M., Shardha, R., Schwimmer, H., ... & Herring, A. A. (2023). Effectiveness of substance use navigation for emergency department patients with substance use disorders: an implementation study. Annals of Emergency Medicine, 81(3), 297-308.
    https://www.sciencedirect.com/science/article/pii/S0196064422011647

References:

  1. Centers for Disease Control and Prevention. (2024). DOSE Dashboard: Nonfatal Overdose Syndromic Surveillance Data.
    https://www.cdc.gov/overdose-prevention/data-research/facts-stats/dose-dashboard-nonfatal-surveillance-data.html
  2. Liu, S. (2020). Nonfatal drug and polydrug overdoses treated in emergency departments—29 States, 2018–2019. MMWR. Morbidity and mortality weekly report, 69.
    https://www.cdc.gov/mmwr/volumes/69/wr/mm6934a1.htm
  3. Sokol, R., Tammaro, E., Kim, J. Y., & Stopka, T. J. (2021). Linking MATTERS: barriers and facilitators to implementing emergency department-initiated buprenorphine-naloxone in patients with opioid use disorder and linkage to long-term care. Substance Use & Misuse, 56(7), 1045-1053.
    https://www.tandfonline.com/doi/full/10.1080/10826084.2021.1906280#abstract