{"pk":17933,"title":"Flow Through the Emergency Department for Patients Presenting with Substance Use Disorder in Alberta, Canada","subtitle":null,"abstract":"Introduction:\n Since 2016 the province of Alberta, Canada, has seen a significant increase in substance use disorder (SUD) presentations to the emergency department (ED) with a large surge during the COVID-19 pandemic. In this retrospective study we deconstruct the total length of stay (LOS) in the ED into stages for patients presenting with SUD and estimate the effects of covariates on the time to transition between stages.\nMethods: \nUsing the Canadian Coding Standards for International Classification of Diseases, 10th Modification, codes F10.0-F19.9 and T36.0-T50.9, we extracted data from the National Ambulatory Care Reporting System between April 1, 2019–March 31, 2020 on all ED presentations for SUD by Alberta residents.We used a multistate model to deconstruct theEDLOS into eight mutually exclusive states and determine which factors affected the time spent in each state.\nResults:\n We analyzed 66,880 presentations (37,530 patients). The mean age was 37.2 years, and 61% were male. The median total LOS in the ED was 6 hours 13 minutes. Patients presenting with methamphetamines (METH) intoxication and patients from low-income neighborhoods had significantly increased transition times between all states. Opposite this, opiate use was associated with faster transition times between almost all states. Metro EDs experienced slower transitions when attempting to discharge or admit patients when compared to urban or rural EDs. Emergency department crowding also had a dramatic effect on physician initial assessment times, while discharge and admission times in patients presenting with SUD were also significantly affected.\nConclusion:\n Patients with SUD experience a variety of delays during their ED stay. Those with METH intoxication and those from the lowest income neighborhoods were most likely to experience slower transitions from state to state in the ED and may benefit from a focused approach to improve ED flow.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"emergency department"},{"word":"Time to physician initial assessment"},{"word":"Length of Stay"},{"word":"Multi-state models"},{"word":"Substance Use Disorder"}],"section":"Behavioral Health","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8x79h4xz","frozenauthors":[{"first_name":"Jonah","middle_name":"","last_name":"Edmundson","name_suffix":"","institution":"The King’s University, Department of Biology, Edmonton, Canada","department":"None"},{"first_name":"Kevin","middle_name":"","last_name":"Skoblenick","name_suffix":"","institution":"University of Alberta, Department of Emergency Medicine, Edmonton, Canada; Royal Alexandra Hospital, Edmonton, Canada; University of Alberta, Neuroscience and Mental Health Institute, Edmonton, Canada","department":"None"},{"first_name":"Rhonda","middle_name":"J.","last_name":"Rosychuk","name_suffix":"","institution":"University of Alberta, Department of Pediatrics, Edmonton, Canada; Women & Children’s Health Research Institute, Edmonton, Canada","department":"None"}],"date_submitted":"2023-03-06T14:09:32-08:00","date_accepted":"2023-03-06T14:09:32-08:00","date_published":"2023-07-07T11:16:45-07:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/17933/galley/9152/download/"}]}