Table 1 Healthcare workers’ perceptions of ED factors as facilitators and barriers

Patient volumes in the ED, competing priorities

19/37 (51%)

(10 nurses, 3 pharmacists, 5 physicians, 1 social worker)

So, one patient, and this was the patient who had never been on Suboxone [buprenorphine/naloxone] before, and … was an overnight patient. But our department was not busy, and I believe he probably came in around three or four in the morning and he was willing to wait ‘til the morning. (Physician 010)

…there’s people that are sicker and require more intervention and more attention. (Nurse 201)

…there are so many patients in emerg and there are so many things that … I’m doing. (Pharmacist 105)

Availability of space

10/37 (27%)

(4 nurses, 2 pharmacists, 4 physicians)

…she had already had … an appropriate bed (Pharmacist 108)

…our department was not busy … There was no need for space. (Physician 010)

So they were in the hallway in a chair, which made it kind of hard to communicate in a way that was really supportive regarding Suboxone [buprenorphine/naloxone]… it really wasn’t an ideal location to be sitting and...having this confidential conversation. (Nurse 213)

Time required & time available

6/37 (16%)

(3 nurses, 1 pharmacist, 2 social workers)

[None]

…those issues are usually quite large and in-depth … But we often don’t have the time because it’s like 'oh, now I have to go attend to a cardiac arrest, so see you later.’ (Nurse 205)

I think, the trick with these—this patient population, is you got to really spend the time building rapport and relationship with them to be able to, you know, successfully introduce these ideas. (Social worker 301)

Environment or atmosphere

3/37 (8%)

(1 nurse, 1 physician, 1 social worker)

So yes, you’re [in] an emergency department. You’re in a safe environment, you’re getting your needs met, whether the medication, food… (Social Worker 304)

…. the emergency department isn’t an appropriate place to do a regular [standard] induction. It’s chaotic, it’s loud, it’s bright, it stinks… sometimes, and … you’re nauseous, you’re having diarrhea, you don’t have the access to a toilet. (Nurse 201)