Service use and program-level impacts of a collaborative hospital-community emergency department diversion program for people experiencing alcohol and opioid intoxication

OBJECTIVES: People experiencing substance use problems frequently use emergency departments (EDs). Some ED visits may be safely divertible to non-medical settings. This study evaluated the service use and program-level impacts of the Stabilization and Connection Centre (SCC), an ED diversion program for people experiencing alcohol and/or opioid intoxication in Toronto. METHODS: This retrospective cross-sectional study used administrative data from 1/1/2023 to 12/31/2024 to describe SCC visitor volumes and characteristics. Poisson and linear regression models were fitted to examine the temporal and environmental correlates of SCC visit counts, and differences in lengths of stay and paramedic transition times at the SCC compared to patients presenting to two nearby EDs for substance intoxication. RESULTS: There were 4574 SCC visits during its first two operational years, with most visitors being male, 24-54 years of age, and homeless. Lengths of stay at the SCC (M = 10.11 h, SD = 8.38) were significantly longer than in the comparison group visiting the ED (M = 4.61 h, SD = 4.22). Paramedic transfer of care times were also significantly shorter at the SCC (M = 7.20 min, SD = 3.62) than the ED (M = 34.10 min, SD = 45.22). SCC visits were significantly lower during the winter and weekdays, but higher on days when nearby EDs were busier and during the week when monthly income support payments are issued. CONCLUSION: The SCC was associated with some intended program-level outcomes in the forms of safe ED diversions of patients experiencing intoxication and reduced paramedic transfer of care times.