Plenary Session 3: Overdose Fatality Review and Substance Misuse Interventions in the Emergency Department

Knox County, Tennessee, established its overdose fatality review (OFR) team in 2021, and as of October 2022, the team had reviewed 105 cases. In its first annual report, the OFR team identified hospital emergency departments (EDs) as a high-priority setting for substance misuse interventions and overdose prevention. Of the first 105 cases the team reviewed, 22 were excluded because of lack of medical data. Among the remaining 83 individuals with sufficient data, there were 711 lifetime ED visits. Of these 83 individuals, 69 visited the hospital within 1 year of death, totaling 335 hospital visits. Chart notes showed a pattern across individuals of leaving the hospital against medical advice, and OFR team members inferred from their experience that withdrawal symptoms played a role in many of these cases. Each hospital visit represents an opportunity to intervene and prevent a death by overdose. University of Tennessee Medical Center (UTMC), a local hospital system that is represented on the OFR team, has begun a pilot program to bridge the gap between hospitals and drug treatment programs by initiating medication for opioid use disorder in the ED and then a warm handoff to a grant-funded intensive outpatient program (also represented on the OFR team). The OFR team has convened a work group to evaluate the success of UTMC’s program and discuss expanding it to other area hospitals, especially those with existing peer navigator programs. The work group includes the founder of a national ED/medical staffing company and representatives from local behavioral health providers.