VA ED Bridge Training Toolkit

The Emergency Department (ED) is at the frontline of the opioid crisis that has had a stronghold on our region; ours has often seen the highest rates of overdose visits of any ED in Virginia. The ED is an obvious entry point into a health care system for those dealing with an opioid-use disorder. The Bridge to Treatment Virginia Expansion Project is transforming emergency rooms into places where effective treatment starts and the road to recovery begins. Best practice interventions during the ER visit provide relief from withdrawal symptoms. Post overdose a compassionate well-informed response with a timely handoff to appropriate addiction treatment can prevent another overdose and open doors to long term recovery.

Goal

The goal is to link our vulnerable patients—who may come to the ED with opioid-related infections, opioid withdrawal or overdose—with appropriate medical care that can start them on the path toward disease management and lifelong recovery. The program began on Jan. 1, 2019, led by John Burton, M.D., chair of Emergency Medicine, and Cheri Hartman, Ph.D., ED Bridge to Treatment project director. The Virginia Department of Health (VDH) and the Department of Medical Assistance Services have funded project development and expansion across Virginia.

Strategy

The ED Bridge is a collaboration between Carilion Emergency Services, Carilion Mental Health, peer recovery specialists, Carilion Research and Development, HART analytics, and the outpatient office-based addiction treatment (OBAT) clinics to ensure appropriate, timely access to care. The ED Bridge Training Toolkit is designed to equip other health care systems to use these methods found to increase the likelihood that a patient will initiate treatment and avoid return visits to the ER. The various sections of the “toolkit” address such topics as “getting started – replacing stigma with science,” how and why to use medications in the ER approved by the FDA for opioid use disorder treatment, lessons learned about linking peer recovery specialists with one’s patients, how to work with special populations (eg, pregnant women, releases from incarceration), tracking and monitoring progress and celebrating successes.

Reinforcing hopeful messaging associated with an anti-stigma, science-based approach to care has led to improved outcomes and an increased belief that recovery is attainable with the help of treatment.

The ED Bridge Virginia Expansion Project is funded to provide guidance, technical assistance, trainings, learning collaboratives and access to this interactive Training Toolkit. This is available to health care systems interested in developing such a solution for helping more patients access the treatment they need. The aim is to build capacity throughout Virginia to create similar programs to combat the opioid crisis in Virginia.