Table 3 Multilevel implementation strategies to support ED initiation of buprenorphine through the integration of the EMBED clinical decision support tool, grouped by PRISM domain. Each strategy was also placed within the corresponding conceptual category according to the groupings from the ERIC project [35]

Intervention (organizational perspective)

• Tailor intervention to the local environment (adapt and tailor to context)

• Low complexity/intuitive CDS tool (support clinicians)

• Observability—provide feedback to clinicians when patients have positive outcomes, both in the short term (e.g., improved symptoms while in the ED) and long term (e.g., patient establishes care for OUD treatment after discharge) (use evaluative and iterative strategies)

• Identify existing interdisciplinary team members in the ED and the organization to implement the intervention and develop workflows to facilitate coordination and completion of key tasks (support clinicians)

Recipients (organizational characteristics)

• Create policies and best practices that prioritize patients with OUD (change infrastructure)

• Organizational support for interdisciplinary team members to implement the intervention in the ED and organization (support clinicians)

• Incentives/mandates for X-waiver (change infrastructure)

• Develop and support local champion(s) (develop stakeholder interrelationships)

Recipients (patient characteristics)

• Resources and counseling for patients on options (including harm reduction strategies) when patients are not ready to initiate buprenorphine (engage consumers)

Implementation and sustainability infrastructure

• Sufficient training for prescribing clinicians (train and educate stakeholders)

• IT/EHR support (change infrastructure)

• Routine monitoring and feedback on both CDS use and buprenorphine initiation (use evaluative and iterative strategies)

External environment

• Develop partnerships to refer a patient for ongoing OUD treatment (develop stakeholder interrelationships)