ED Bridge to Treatment Program Offers Training to Other Health Systems

Almost 2,000 Virginians died of opioid overdose in 2020, and the rate of overdose fatalities in the Roanoke region—80 per 100,000—exceeded the state rate. As stark as those numbers are, they would likely have been higher if not for our ED Bridge to Treatment program.  

The program was established in late 2018 to link Emergency Department (ED) patients experiencing opioid withdrawal, overdose or related infections with appropriate medical care that can start them on the path toward disease management and recovery. It is funded by the Virginia Department of Health and the VA Department of Medical Assistance Services, and it is led by John Burton, M.D., chair of Emergency Medicine, and project director Cheri Hartman, Ph.D., who also administers our outpatient office-based opioid treatment (OBOT) program.

As a result of the program, our ED was one of Virginia's first to ​implement an OBOT preferred gold standard model program combining ​onsite therapy, peer recovery specialists and care coordination with the medication buprenorphine to initiate treatment for opioid addiction. During its first two years, 30 Carilion ED physicians completed special waiver training by the Substance Abuse and Mental Health Services Administration (SAMHSA) to administer buprenorphine. The federal Drug Addiction Treatment Act, which requires the waivers, now allows SAMHSA to grant waivers to all credentialed physicians (M.D. and D.O.) and certified advanced care practitioners who have a DEA number.

Find out how the ED Bridge to Treatment program works in this previous article.

The program was an immediate success: None of the first 44 patients who successfully crossed into treatment returned to the ED.

That initial success has continued in the two years since, even under the added stress of the pandemic:

• In the first year, 82% of patients appropriate for outpatient care successfully crossed the “bridge” from the acute care ED setting into the office-based opioid treatment program. 
• In the second year, this success rate remained high at 78%.

"The program has exceeded our expectations and we are on the cutting edge; we're making a tremendous difference in lives," said Dr. Burton.

Leading Virginia’s Fight Against Overdose Fatalities

The pilot ED Bridge to Treatment program is charged with informing, instructing and inspiring other EDs to create similar programs to help combat the opioid crisis throughout Virginia. This replication project is funded by the Virginia Department of Medical Assistance Services (DMAS), supplementing the funding from the Virginia Department of Health.

DMAS recently contracted with Carilion Clinic to design an educational curriculum for other EDs to develop and implement bridge clinics unique to each health system. Participant systems will receive free training tools, including access to a free training video, as well as technical assistance from Carilion. Dr. Hartman will work to determine participant health systems' readiness and explore their relationships with local community addiction treatment clinics.

"A key lesson learned from the Carilion quality improvement study of the ED Bridge to Treatment is the value of an interdisciplinary team that can leverage the assets of a range of departments," said Dr. Hartman. "An amazing team has collaborated to create rapid access to best-practice treatment and impact this tragic epidemic."

Participating departments include:

• Behavioral Health
• Community Health and Outreach (peer recovery specialists)
• Emergency Medicine
• Family Medicine
• Pharmacy
• Research and Development
• TSG

Watch a short version of the training video above, and follow this YouTube link to view a longer version. 

For more information, contact Cheri Hartman, Ph.D., Psychiatry and Behavioral Medicine, at cwhartman1@carilionclinic.org or call 540-981-7099 (77099).