NSG/544 Week 1: Data for Strategic Planning, sample paper

Should the Emergency Department Start Buprenorphine? Using Five Years of Overdose and Addiction Data to Inform a Community Hospital's Strategic Plan

[Student Name]

University of Phoenix

NSG/544: Evaluation and Application of Information

Week 1 Assignment

[Instructor Name]

[Date]

The hospital, its county and all data are a composite written for a model paper.

Every three years, our 210-bed community hospital updates its strategic plan, and this year the planning committee asked nursing informatics for data on one question: should the hospital invest in an emergency department program to start buprenorphine for patients with opioid use disorder, with a bridge clinic to keep them in treatment until community care begins? This paper shows how data can inform that decision.

Why Data Belong in Strategy

Strategic planning sets priorities for years and commits money and staff. Decisions based on impressions tend to follow whoever speaks most forcefully; decisions based on data can be tested and revisited. Data do not make the decision, which also involves mission, values and money, but they define the problem's size, its direction and what is likely to work. The informatics nurse's job in strategic planning is to make sure the committee argues about the right numbers.

Internal Data: The Hospital's Own Experience

Four internal data sets were assembled. First, emergency department visits coded for opioid overdose over five years: 64 in the first year, rising to 148 in the most recent year. Second, visits with a documented diagnosis of opioid use disorder for any reason, including infections from injection, withdrawal and injuries: 412 in the most recent year. Third, return visits: of patients seen for an opioid overdose, 31% returned to the emergency department within 90 days, and 11 died within a year according to the state death index match performed by the quality department. Fourth, current practice: in the past year, 6 patients received buprenorphine in the department, all continuing prescriptions they already had; none were started on treatment.

External Data: The County and the Nation

External data put the hospital's experience in context. The county health department's data showed opioid overdose deaths in the county rising for four consecutive years. Nationally, an analysis of emergency department data from 52 jurisdictions in 45 states found 142,557 visits for suspected opioid overdose from July 2016 through September 2017, with the rate rising an average of 5.6% per quarter and increases across all five U.S. regions (Vivolo-Kantor et al., 2018). The hospital's growth in overdose visits is therefore part of a wider pattern rather than a local anomaly.

Evidence on What Works

Data on the problem must be paired with evidence on solutions. In a randomized trial, 78% of patients with opioid dependence who started buprenorphine in the emergency department were engaged in addiction treatment 30 days later, compared with 37% of those given referral information and 45% of those given a brief intervention with facilitated referral, and the buprenorphine group reported fewer days of illicit opioid use per week (D'Onofrio et al., 2015). That result gives the committee a realistic expectation of what an emergency department program might achieve.

A Change in the Rules

One barrier to such programs has changed. Until 2023, clinicians who wanted to treat opioid use disorder with buprenorphine outside specialized programs had to obtain a separate federal waiver first, and few emergency physicians had done so. Federal legislation enacted at the end of 2022 removed that waiver requirement (Consolidated Appropriations Act, 2023, 2022). Any clinician with a standard controlled-substance registration can now prescribe it, which lowers the cost and complexity of starting a program.

Interpreting the Data for the Decision

Taken together, the data make four points. The problem is large and growing at the hospital: overdose visits more than doubled in five years. It is serious: nearly a third of overdose patients return within 90 days, and some die within a year. The hospital currently does almost nothing to start treatment. And evidence suggests that starting buprenorphine in the emergency department roughly doubles engagement in treatment at 30 days compared with referral alone.

What the Data Cannot Say

The data have limits the committee should hear. Coding of overdose visits depends on documentation and may undercount visits where the substance was not identified. The trial took place in an urban academic center, and results in a community hospital may differ. The hospital's return-visit rate does not capture patients who went to other hospitals. And the death index match covers only in-state deaths. These limits argue for building measurement into any program from the start.

Options for the Committee

The data support three options. Option A: continue current practice, accepting rising visits and returns. Option B: start emergency department-initiated buprenorphine with warm handoff to existing community clinics, at modest cost for training and a peer recovery coach. Option C: Option B plus a hospital bridge clinic that sees patients within 72 hours until community care begins, at higher cost but closing the gap between the emergency visit and the first community appointment, which in our county currently averages 18 days.

Recommendation Framed by Data

Given the size and trend of the problem, the evidence on effectiveness and the removal of the waiver barrier, the data support Option B at minimum. Option C is supported if the 18-day wait for community care is confirmed, since patients may not stay in treatment for that long without support. The committee should also approve a measurement plan: patients started on buprenorphine, engagement at 30 days, return visits and overdose deaths.

Stakeholders and Their Questions

Different committee members will read the data through different questions. The chief financial officer will ask what the program costs and what it returns; the emergency department medical director will ask about workload and training; the chief nursing officer will ask about nursing roles, such as withdrawal assessment and naloxone teaching; and community board members will ask what difference the program will make to the county. Preparing the data with those questions in mind, for example by estimating the cost of a peer recovery coach alongside the evidence on engagement, makes the presentation useful to each of them.

Data the Hospital Does Not Yet Have

Planning also revealed missing data. The hospital does not know how many patients with opioid use disorder want treatment, how many have insurance that covers buprenorphine or how long community clinics take to see new patients from the emergency department. The 18-day figure comes from a phone survey of three clinics, not from tracked referrals. A strategic plan can commit to collecting these data as part of the program, which turns the missing pieces into early measures rather than reasons for delay.

Presenting to the Committee

The data will be presented in one page with three charts: overdose visits over five years, return visits within 90 days and a comparison of engagement rates from the trial. Each chart will state its source and limits beneath it.

Conclusion

Internal data showed a doubling of overdose visits, frequent returns and no treatment starts; external data placed that experience in a national trend; research evidence showed what emergency department-initiated buprenorphine can achieve; and a change in federal law lowered a barrier. Together, the data support a strategic commitment to start treatment in the emergency department, with measurement built in.

References

Consolidated Appropriations Act, 2023, Pub. L. No. 117-328, 136 Stat. 4459 (2022).

D'Onofrio, G., O'Connor, P. G., Pantalon, M. V., Chawarski, M. C., Busch, S. H., Owens, P. H., Bernstein, S. L., & Fiellin, D. A. (2015). Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: A randomized clinical trial. JAMA, 313(16), 1636-1644. https://doi.org/10.1001/jama.2015.3474

Vivolo-Kantor, A. M., Seth, P., Gladden, R. M., Mattson, C. L., Baldwin, G. T., Kite-Powell, A., & Coletta, M. A. (2018). Vital signs: Trends in emergency department visits for suspected opioid overdoses, United States, July 2016-September 2017. Morbidity and Mortality Weekly Report, 67(9), 279-285. https://doi.org/10.15585/mmwr.mm6709e1