Table 1.

Needs assessment at baseline and ethnographic observation results.

Needs/topics	How they were expressed
Appropriate patient identification	Is it possible to have nurses identify patients with OUDa?
	Need to properly explain COWSb to patients, who may understand it as “dope sick”
	Can discharge instructions for opioid abuse be a trigger to activate CDSc?
	There needs to be advanced search terms to trigger the CDS system—BPAsd should not be the common denominator for analysis
Avoiding workflow disruptions	Avoid BPAs. They are intrusive and are rarely acted upon
	Sometimes, physicians do leave electronic health record to access MDCalc or clinical resources websites
	Attending physicians usually do not have time for decision support. Better to tailor this toward residents and nurses
	Entire intervention should take 2-5 mins to increase adoption
Streamlining CDS steps	Integrate COWS into the H & Pe template, with integrated decision support and order sets to determine the need for BUPf
	If a user is initiated for OUD diagnosis, then workflow should be streamlined and skip through the diagnostic criteria for OUD and go straight to treatment decision support
Understanding treatment process	Should patients be given a 4 mg or an 8 mg dosage?
	Need to have a short SBIRTg included in CDS to assess patient willingness to begin treatment
	This is not the responsibility of our department but rather the substance abuse program
	Patients are rarely in the right range of withdrawal to prescribe BUP. Need to have a system to allow them to return at an appropriate time to the EDh
	Some patients may have a preference for suboxone versus methadone
	Some providers may have completed the waiver process but may not yet be recognized for it
	Should we have patients return to the ED for follow-up post BUP administration, using the 72-hour rule?

^aOUD: opioid use disorder.

^bCOWS: Clinical Opioid Withdrawal Scale.

^cCDS: clinical decision support.

^dBPA: best practice alert.

^eH & P: history and physical.

^fBUP: buprenorphine.

^gSBIRT: Screening, Brief Intervention, and Referral to Treatment.

^hED: emergency department.