Since 2019, Roanoke, Va.-based Carilion Clinic’s emergency department Bridge to Treatment program has redefined how the system connects patients with opioid use disorder to recovery resources.
Robert Trestman, MD, PhD, professor and chair of the department of psychiatry and behavioral medicine at Virginia Tech Carilion School of Medicine and Carilion Clinic, spoke with Becker’s about what it took to create and scale an effective, evidence-driven model across seven hospitals in Virginia.
Editor’s note: These responses have been lightly edited for clarity.
Question: The Bridge to Treatment program began in 2019 and was modeled in part on research from Yale and Harvard. What inspired your team to bring this evidence-based approach to Carilion?
Dr. Robert Trestman: Our region was among the hardest hit in terms of opioid addiction and deaths by overdose. It was apparent that we needed to do things differently to treat addiction and overdose when people presented to the emergency department. This is what drove our search for appropriate models of care and our adoption of the Bridge to Treatment Program.
Q: The program helped raise follow-up treatment rates from 10% to 82% within its first year. What were the most important steps or strategies that made such a dramatic improvement possible?
RT: This was a coordinated effort between the department of emergency medicine and the department of psychiatry. The emergency medicine physicians were all trained in the use of Suboxone for the treatment of addiction, including their comfort and willingness to write a prescription for 72 hours of medication as appropriate to each individual. This was a major culture change that helped to support our overall goals. Embedding peer recovery specialists in the emergency department was another key component. These individuals with lived experience bring credibility and a level of trust that otherwise was lacking. And finally, having direct and immediate access to follow-up treatment that was coordinated with the emergency department work was the next major component.
Q: A key part of the program is immediate access — from on-the-spot prescriptions to peer recovery support and community provider connections. What has been most effective in keeping patients engaged after discharge?
RT: Many of our patients are housing insecure or, frankly, homeless. Helping to support and coordinate with them is difficult, as their lives are filled with challenges. Our peer recovery specialists and care coordinators work hard to engage our patients and find effective strategies to allow them to continue their care.
Q: With support from the Virginia Department of Health, Carilion is now helping seven other hospitals implement this model. What have you learned about scaling the program — and what advice would you offer other systems looking to replicate your success?
RT: This is really a culture change that requires buy-in from all the involved disciplines. It requires treating our patients with dignity and respect, even when at this point in their lives, many of our patients have lost their own ability to treat themselves with dignity. It requires building the infrastructure to coordinate the process of care delivery. It requires clinicians comfortable managing the addiction and the challenges that people living with addiction who are early in recovery may present. We would encourage people to enter into this process who have a commitment to improving their community’s well-being and their patients’ health. It means that they will be willing to potentially look at the way they deliver care, the way they view their patients and the level of creativity they are willing to exercise to successfully implement their own bridge to treatment program.
