When it comes to developing an emergency department (ED)-based treatment and referral program for patients who present with opioid use disorders (OUD), there is no need to scrounge for tools, processes, or information. Multiple pioneers in this area are freely sharing how their own programs work and what instruments they use.
For instance, many assessments and algorithms used in the ED at Yale-New Haven Hospital are available to any facility that wants to start. (Learn more here.) In the same vein, the California Bridge Project, which is rapidly helping EDs throughout the state implement programs, offers tools, education, and other resources for download through its website. (Learn more here.)
Arianna Sampson, PA-C, a regional director for the California Bridge Project, advises emergency medicine colleagues interested in developing programs to ensure their pharmacist maintains buprenorphine in the formulary so ED providers can access and administer the drug easily.
When working with community-based treatment providers, keep the referral process simple, Sampson advises. “We literally have an appointment time set every single day at 9 a.m. We tell the patient to show up at the clinic the next day at that time,” she says. “We didn’t want to have someone have to call around ... so we just made it no nonsense.”
Sampson credits the established, premade appointment time for the high follow-up rate for patients initiated on buprenorphine in the ED. “We have excellent partners,” she says. “We just start people on the right medication, and they take over.”
Some clinicians struggle to engage with patients about OUD. Even Sampson acknowledges such conversations used to feel awkward. However, creating a good treatment option has made such encounters much easier.
Also helpful: Signage in the ED indicating addiction treatment is available. Sampson wears a button on her coat that reads “treatment starts here.” Thus, it is not uncommon for patients to bring up the subject. “The important thing is for patients to feel like they can self-disclose,” Sampson says. “I had someone who came in following a car accident. He was there for a totally different reason, and he asked for help. I asked him what made him feel like he could talk to me about this. He said he saw the button on my jacket.”
When Sampson wants to raise the subject of drugs or alcohol, she starts by asking the patient for permission. “It’s just showing that respect,” she observes. “I haven’t had anyone say no.”