Carilion awarded $1.9 million for statewide expansion of successful Emergency Department Bridge to Treatment program for opioid use disorder patients

The Virginia Department of Health Injury and Violence Prevention Program awarded Carilion a $1.9 million grant to launch a statewide expansion of the healthcare system’s Emergency Department (ED) Bridge to Treatment program.

The Carilion ED Bridge to Treatment Virginia Expansion Collaborative Project will take lessons learned by Carilion’s Bridge Program on the road to seven early implementer hospitals across the commonwealth,  funding ongoing technical assistance by Carilion teams who will support peers as they build their own programs.

“The collaboration and interest in this program across the state have been astounding,” said Cheri Hartman, PhD, ED Bridge project director for Carilion. “Addiction is a disease, and the expansion of bridge programs represents a needed cultural shift in caring for substance use disorder patients, connecting them with compassionate care and significantly increasing their chance for a long-term recovery.”

In the ED Bridge to Treatment model, patients who present with a non-fatal overdose, acute withdrawal symptoms or requesting treatment will be rapidly connected with follow up care matching the severity of their disease.  A medical bridge from acute care to follow up treatment is provided through prescriptions, peer supports for the transition, and rapid access to the treatment providers for ensured continuity of care.  Post ED-discharge patients are evaluated in the Department of Psychiatry and Behavioral Medicine and triaged to the service level that is needed, ranging from residential treatment to the ambulatory office-based addiction treatment offered in Psychiatry’s ambulatory clinic.

Carilion first offered this program in 2018 and has studied the success rates of patients accessing follow up treatment in the Psychiatry outpatient clinic. Chair of the Emergency Department, John Burton, MD, acknowledged that at best only about 10 percent of patients presenting in the ER with an acute opioid use disorder symptom got into treatment prior to the bridge. Once this medical bridge was created, the success rates have been as high as 82 percent in year one; 78 percent in year two and 71 percent in year three.  This success rate was identified in a quality improvement study supported by the VA Department of Health and the VA Department of Medical Assistance Services (DMAS).

“The specialty of emergency medicine continues to evolve in its understanding of addiction, and the needs of those afflicted with addiction in their lives,” said Dr. Burton. “The opioid epidemic has been a sentinel event over two decades for the specialty and hospitals to understand our role in addiction treatment and recovery.”

Collaboration between Carilion statisticians, research coordinators, health care teams in the Emergency and Psychiatry and Behavioral Medicine Departments, pharmacists and peer recovery specialists in the Community Health and Outreach division has made the successful bridge to treatment program possible. The model adopted by Dr. Burton was backed by evidence at key academic centers:  Yale and Harvard Universities, as well as a successful program in Oakland, Calif. Carilion’s outcomes have mirrored those of the seminal studies in this field and provide a framework for others in the state.  

In addition to ongoing support and consultation at peer sites, this grant will fund quarterly Learning Collaborative meetings, sponsorship of an ED Bridge to Treatment Conference mid-September at Hotel Roanoke and the creation of an ED Bridge to Treatment Training Toolkit for future use and program adaptation. The total project cost is anticipated to reach $1.9 million.  The target date for completion is June 30, 2024. VHHA is partnering with Carilion Clinic to help with an addiction awareness campaign to garner broad support for expanding the Ed Bridge to Treatment model. 

“Our goal is to offset continued stigmas against addiction, starting with how patients are able to access care,” said Dr. Hartman. “Perhaps most exciting is that this expansion will allow our work to benefit patients far beyond our immediate community. It is the untreated patient who overdoses; getting more persons with an opioid use disorder into treatment saves lives.”