Table 2 Site characteristics overview
| Â | Valley Regional Healthcare | Catholic Medical Center | Bellevue Hospital Center |
|---|---|---|---|
Patient volume | Low (10 K annual ED visits) | Medium–High (35 K annual ED visits) | Very High (120 K annual ED visits) |
Patient need | High – High rates of OD; Fentanyl-only drug use common | High - High rates of OD; Fentanyl-only drug use common | High – High prevalence of medical-psychiatric co-morbidity and social disadvantage |
Setting | Rural | Urban with suburban and rural catchment zone | Urban |
Institution | Private, critical access community hospital | Private, community hospital | Municipal, Academic-Affiliated, Tertiary Care Hospital and Level 1 Trauma Center |
Referral options | Low | Medium | High |
ED Physician Staffing | Single coverage, non-EM trained; some locums (non-permanent staff) | Temporarily assigned, locums (non-permanent staff). Pending change to new locums agency | 80 faculty members; 60 residents. Resident-driven model |
ED ancillary staffing | – Social work services not available in ED | – Permanent mid-level providers | – Limited ancillary and support staff |
|  | – No in-hospital addiction or psychiatric specialty coverage | – Limited social work support | – Extremely low nurse to patient ratios (often 1:20 in ED) and hiring freeze |
|  |  |  | – Health coaches and volunteers screen and provide brief interventions for substance use |
Space | No crowding | Significant overcrowding problem | Overcrowding is common |
Unique site characteristics | Extremely limited community treatment options (none known to ED prior to study) | No ED champion. PI outside of ED. Active policy prohibiting the use of BUP in ED. Locum tenens staffing model. No existing heath system addictions care | Local expertise and partnerships exist. Understaffed and fragmented health system and referral network |