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How Emergency Department Bridge Programs Can Benefit Patients and Providers

By: Jessica Heil

The emergency department remains a critical point of entry into treatment for many patients struggling with opioid use disorder. Between 2005 and 2017, emergency department opioid-related encounters increased by approximately 180% (Agency for Healthcare Research and Quality, 2021). Despite this increase, over 86.6% of patients with OUD do not receive evidence-based treatments (Krawczyk, 2022). One of those evidence-based treatments includes buprenorphine, a partial mu-opioid receptor agonist and FDA-approved medication for OUD. While studies show that emergency department initiated buprenorphine increases addiction treatment engagement at 30 days and clear Emergency Medicine organization statement of support, buprenorphine administration and prescribing has been slow to be adopted in EDs. (Rhee et al., 2020; D’Onofrio et al., 2023; D’Onofrio et al., 2019; D’Onofrio et al., 2015). Reported reasons for the slow uptake include a lack of structural support, stigma, training, and experience in treating opioid use disorder, and the inability to link to ongoing care (Cao et al., 2020). Despite these barriers, where emergency departments have effectively implemented buprenorphine with linkage to affiliated clinics, also known as ED Bridge Program, patient outcomes have been positive.

An ED Bridge Program connects ED patients with substance use disorders, specifically OUD, to follow-up care. The follow-up care could involve a clinic within the ED itself or an affiliated community clinic. In addition to linking the patient to care, the ED Bridge Program can start or dose patients on medication for opioid use disorder (MOUD), receive a prescription for MOUD, or receive care coordination from a substance care coordinator. ED Bridge programs are required to have an ED clinician champion, an outpatient provider able to receive patients on buprenorphine, and support from hospital leadership

Until now, the literature has largely focused on the benefits of ED Bridge Program to patients. However, when Emergency Medicine Physicians were interviewed about how the Emergency  Department Bridge Program affected them personally and professionally, they felt a renewed sense of fulfillment and purpose in their personal and professional lives (Heil et al., 2024). Emergency Medicine Physicians from Emergency departments who had robust ED Bridge Programs in place from four geographically diverse locations were interviewed about their perceptions of prescribing buprenorphine and referring patients to long term care in the ED. Three major themes emerged after interviewing Emergency Medicine Physicians:

1. Providers gained agency through their participation in ED Bridge Program:

  • Emergency Medicine Physicians expressed a newfound sense of agency, enabled by the ED Bridge Program, allowing them to use effective treatment to patients with OUD.
  • ED Bridge Programs facilitated access to treatment options, addressing barriers and empowering Emergency Medicine Physicians to contribute to patients’ recovery.

2. Transformation in providers’ emotions, attitudes, and behaviors:

  • Physicians reported a shift from judgmental and pathological attitudes towards patients with OUD to more holistic understandings.
  • Participation in ED Bridge Programs fostered empathy and positively influenced physician-patient relationships, leading to advocacy for patients among colleagues.

3. ED Bridge Program participation improved professional quality of life:

  • Emergency Medicine Physicians shared stories of enhanced professional quality of life, feeling more helpful, appreciated, and supported.
  • Physicians perceived improvements in their patients’ quality of life through comprehensive education about OUD treatment, ultimately reducing burnout.

Additional Considerations:

The physicians staffing these emergency departments, emergency medicine physicians, currently have the highest rate of burnout compared to other specialties due to a combination of demanding clinical practice and irregular hours (Stehman et al., 2019; Kane, 2022. This burnout has been exacerbated by dueling public health crises: the COVID-19 pandemic, and the overdose epidemic. Emergency medicine physicians actually reported the highest burnout rate of all specialties in 2022 (60%), a large jump from 43% the year prior and likely related to changes in the health system post-COVID (Kane, 2022).

Summary:

As the emergency department continues to serve as a crucial point of entry into the healthcare system for people who use drugs, the positive impact of ED Bridge Programs on emergency physicians underscores the importance of these programs both for patients and for physicians. For Emergency Medicine Physicians who struggle with increased burnout, this work may positively impact agency, quality of life, and lead to positive transformation. By demonstrating the positive impact of these programs on patient outcomes and the well-being of frontline healthcare providers, the research underscores the importance of their widespread adoption within healthcare systems. These findings provide compelling evidence to support initiatives aimed at implementing and scaling up ED Bridge Programs, thereby enhancing the quality of care delivery, reducing healthcare strain, and fostering a healthier work environment for frontline staff. Future research should explore these dynamics in diverse settings to broaden the understanding of the potential benefits of ED Bridge Programs.

Key takeaways:

  1. Emergency departments have become critical points of entry into treatment for patients with OUD.
  2. Participating in ED Bridge Programs benefits patients and positively impacts EPs.
  3. This research can be used to encourage hospitals to implement ED Bridge Programs that were otherwise reluctant.

Read more about this research study: A qualitative assessment of emergency physicians’ experiences with robust emergency department buprenorphine bridge programs

About the Author 

Jessica Heil is a research coordinator at Cooper University Health Care’s Division of Addiction Medicine. Prior to joining Cooper she received her Master of Science in Public Health Microbiology at George Washington University. She uses qualitative and quantitative research to help improve and expand access to evidence based care for people with substance use disorders.