OSI-Baltimore is proud to release a report that summarizes our work with several local hospitals over the last several years, to explore ways to divert opioid users from Emergency Departments and toward more long-term, holistic care. The report, “Hospital Innovations to Reduce Emergency Department Utilization Among People with Opioid Use Disorder,” is part of the OSI-Baltimore Briefs series, which is intended as a resource for for other cities to learn about innovative work we are supporting in Baltimore.
Following is a letter that OSI-Baltimore Director Danielle Torain sent to colleagues working in public health, along with a physical copy of the report. If you would like physical copies, please email Evan Serpick.
Open Society Institute-Baltimore is thrilled to share the enclosed report, “Hospital Innovations to Reduce Emergency Department Utilization Among People with Opioid Use Disorders.”
Overdose deaths continue to devastate communities across the country, particularly communities of color, including those in Baltimore City. According to provisional data from Centers for Disease Control and Prevention (CDC), 105,752 Americans died from preventable overdose in 2021—a 16 percent increase from 2020. Maryland ranks in the top five states in overdose deaths per capita, more than half of which occur in Baltimore City. In Baltimore, as elsewhere, the dramatic numbers of opioid overdoses and deaths are evident in the city’s crowded Emergency Departments (EDs). Despite advances in evidence-based treatment, these numbers are increasing unabated: Maryland ranks second among states for Opioid Use Disorder (OUD)-related ED visits, with a visit rate more than nine times the national average.
Until recently, most hospitals were not prepared to engage people with OUD in treatment. Standard procedure was to administer naloxone, a short-acting drug to rapidly reverse symptoms of overdose, and release patients back into the community. While naloxone can prevent individual overdose death events, it does not treat the underlying OUD and therefore cannot prevent future overdoses. Thus, many patients treated with naloxone in the ED overdose again after being released, often times leading to death.
For more than a decade, OSI has focused on stemming the burden of substance use disorders in Baltimore. In 2016, OSI launched an initiative to help Baltimore’s hospitals implement new policies, data infrastructure, partnerships, and processes to transform the outcomes of ED services for people with OUD. OSI supported hospitals’ efforts to divert people with OUD to ongoing community-based treatment resources and strengthen the continuum of care for these patients through real-time data monitoring. Ultimately, OSI awarded three hospitals, Bon Secours, Johns Hopkins Bayview Medical Center, and University of Maryland Medical System (UMMS), with grants to design ED diversion programs uniquely tailored to each hospital’s gaps and needs.
With OSI support, Bon Secours, Bayview, and UMMS expanded their ED services to better engage people with OUD in effective treatment and connect them with needed resources in the community. In all three hospitals, significant effort was directed to better managing patient referrals to internal and external resources. The results were very encouraging: At UMMS, almost 50% of people referred from the ED to community-based buprenorphine treatment through the initiative successfully enrolled in ongoing treatment. At Bayview, 30-day readmissions to the hospital’s Chemical Dependence Unit dropped from 27.2% to 11.5% in seven months.
The report also includes recommendations that we hope will serve as road map both for Baltimore and other cities and hospital systems looking to divert people with OUD from EDs to ongoing supports in ways that save lives and reduce costs. These include assessing ED infrastructure, identifying and addressing gaps in treatment, and building partnerships among hospitals and state and city health departments to analyze gaps in community resources and invest to expand access to resources.
We welcome feedback on this report and invite partnership on future innovations in this work.