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Resources help ED patients and providers with opioid-use care

St. Paul's Hospital Emergency Department in downtown Vancouver

November 20-26 is National Addiction Awareness Week, an opportunity to learn more about substance use and ending its harms. In Canada, an estimated 21 per cent of people will meet the criteria for addiction in their lifetimes.

A program to support the needs of Emergency Department workers caring for patients with opioid-use disorder (OUD) has resulted in the creation of valuable ED-specific reference tools for patients and staff.

The Learning about Opioid Use Disorder in the Emergency Department (LOUD in the ED program) created the resources to address the need for tools and educational materials focused on these needs. They are available online.

Dr. Isabelle Miles, a physician at St. Paul’s Hospital who helped to organize the program, finds that people are excited to learn about these valuable resources.“ (The ED) is often the sole point of contact for patients with opioid-use disorder,” she says.

Dr. Isabelle Miles

This initiative from the BC Centre on Substance Use at Providence Health and the BC Patient Safety and Quality Council educated ED workers about treating OUD and created ED-specific educational resources. It aims to fill the gaps in addiction care training and delivery in emergency settings.

Why the ED?

For many people who use drugs, the ED is the first, and sometimes only, time they will access the medical system. The stigma surrounding substance use can deter people from seeking care and support elsewhere.

Emergency departments provide a unique opportunity to connect with patients and provide clinical interventions for substance use disorders. Yet many ED teams lack specific training on how to treat these patients. When care providers have the tools to support their patients, it can improve the experience of what might otherwise be a frustrating encounter on both ends. Applying best practices in treating people with OUD in emergency departments improves both patient care and the experience of providing that care.

Improving the quality of OUD care

LOUD in the ED began as a quality improvement initiative involving 24 ED teams from around the province, looking to improve care for patients with OUD. The participating teams engaged with each other to share learnings and insights from their local improvement work. Additionally, two new modules of the Provincial Opioid Treatment Support Program offered by the BCCSU were created by the LOUD in the ED faculty for emergency department clinicians who are treating patients with OUD.

Increasing community connections and reducing stigma

The phase aimed to improve the experience of OUD care for patients and providers in the ED in a few ways: increasing the confidence of health care providers in administering buprenorphine/naloxone, ensuring patients are given information on accessing harm reduction resources, increasing connections to community service, and reducing stigma.

By the end of this part of the initiative, it was clear that there was still a lot to learn. While a survey conducted near the end of the program showed that 90 per cent of responding participants said they increased their confidence in providing OUD care in the ED, it also indicated that there was the need and desire for more educational resources specific to emergency department providers.

“We uncovered a lot of knowledge gaps,” explains Dr. Andrew Kestler, one of the leading faculty members for the program. This instigated the second phase of the project – a series of educational webinars.

Filling the knowledge gaps

The LOUD in the ED faculty created a series of six educational webinars and modules, each on a different theme. They ranged from simpler topics, like a background review of OUD, to more complex ones, like how to care for patients in severe withdrawal. They included relevant cases that people have encountered in practice.

This second phase aimed to create educational tools that were accessible, relevant in an emergency medicine context, and that allowed individuals seek more in-depth knowledge. Each webinar was recorded and came with online modules to allow for further engagement with the material. The webinars and modules are free and available online, so people can continue to benefit from them.

LOUD in the ED has “lasting effect”

“LOUD in the ED is over, but I think it still very much has a lasting effect,” says Dr. Kestler. It has created a resource to help providers learn about treating opioid use disorder in emergency departments that is freely accessible and did not exist before.

As emergency departments are an important point of contact between patients with opioid use disorder and the medical system, it is especially important the health care workers in EDs are educated and equipped to care for people with addictions and opioid use disorder. Through a quality improvement initiative and a series of webinars, the LOUD in the ED program created relevant, accessible educational materials in order to improve opioid use disorder care for both patients and providers.

You can access the webinars from LOUD in the ED here.