Overdose Survivors in the ER: Seizing Opportunity within Tragedy

June 06, 2017

Hospital emergency rooms (ER) across the state are working to realize the potential for opportunity within the tragedy of Pennsylvania’s opioid epidemic. While caring for overdose survivors rescued from death, ERs are working to foster connections that could help those patients recover their lives.

East to West, Rural to Urban, Working on Warm Handoffs

Within the restraints of available resources, hospitals along with government and community partners are fashioning “warm handoffs”—connecting overdose victims to treatment opportunities. Hospital and health system approaches are as varied as their patients and communities.

• Lehigh Valley Health Network secured grant funding for an addiction recovery liaison. This liaison links ER staff to the county authorities responsible for administering community substance abuse programs. The goal is to get overdose survivors who are recovering in the ER into rehabilitation programs.
• WellSpan York and Ephrata Community Hospital ERs have practical, effective warm handoff programs up and running in partnership with RASE (Recovery, Advocacy, Service, Empowerment) Project.

Every overdose patient has the chance to meet with a RASE recovery specialist. RASE specialists are in long-term recovery from substance use disorder themselves. So they are uniquely qualified to motivate these patients to try, or at least think about, recovery.

ER staff call RASE as a routine part of overdose care. RASE counselors are available around the clock every day of the year—whenever those suffering from substance abuse disorder are ready. Counselors stick with patients who pursue recovery, providing ongoing encouragement and support.

Out of 61 overdose cases in York Hospital’s ER since December 2016, more than one in five have agreed to enter treatment. With an average of 25 overdose cases a month, Ephrata Community Hospital started its program in March 2017. A five-year grant through the Lancaster Drug and Alcohol Commission funds this work.

• A collaborative warm handoff program is under way in Bucks County. The Bucks County Health Improvement Partnership brought together the county’s five hospitals and its drug and alcohol commission to develop solutions. Hospitals pair up with treatment centers. The centers provide certified recovery specialists who facilitate warm handoffs with overdose survivors in hospital ERs. Funding comes from the county drug and alcohol commission.

Similar efforts are being rolled out in Montgomery County.

• ERs at Conemaugh Health System and Somerset Hospital have warm handoffs in place. Certified recovery specialists from Alliance Medical Services and Twin Lakes Center counsel overdose survivors.

Now these hospitals are working to move warm handoffs upstream. In addition to overdose victims, patients showing signs of addiction issues will be screened and counseled. Appropriate staff are being trained on evidence-based techniques to screen, briefly intervene, refer, and treat such patients.

Conemaugh and Somerset partnered with treatment centers, United Way, Somerset County, and the Cambria County Drug Coalition to secure grant funding to support this effort.

• Delaware County and Crozer-Keystone Health System were among the first to get a warm handoff program off the ground.

The health system’s new, 52-bed residential treatment center complements its large, well-established outpatient addiction program and its state-designated Center of Excellence. The system manages the recovery specialist team that the county put in place a year ago. As a result, overdose survivors the Crozer-Keystone ERs can take advantage of seamless warm handoffs, from recovery specialist to treatment all within the same health system.

The recovery team has met with 447 patients during the last six months. Nearly 40 percent (167) have begun treatment.

Takeaways for Hospitals, Partners, and Policymakers

The Hospital and Healthsystem Association of Pennsylvania has convened meetings across the state to:

• Answer questions about opioid-related laws already enacted, such as the prescription drug-monitoring program provided for by Act 191 of 2014
• Share among hospitals and others different approaches to warm handoffs and other ways to address the crisis
• Learn more about the challenges hospital face as they help their patients and communities fight addiction

We heard loud and clear that the ravages of the opioid epidemic are common to every community and hospital in our state. But effective, practical solutions must address the specific circumstances of each overdose victim.

Here are key insights from these listening sessions:

• Patient readiness:  Addiction is a chronic, albeit devastating and potentially deadly, disease. Sufferers must be ready to commit to the discomfort, hard work, and big emotional, behavioral, and lifestyle changes needed to overcome addiction long term. Premature efforts to force recovery will end in failure, wasting emotional energy and precious resources.
• The all-important first encounter:  For overdose survivors who are leaning toward being ready, that first contact with a recovery specialist is crucial. Certified recovery specialists have the training and the experience to speak in the way addiction sufferers are most likely to hear.
• Getting quickly into treatment:  We have to help those who are ready to access the right treatment at the right the time—which is right now. Recovery specialists and county drug and alcohol professionals play crucial roles in making sure patients are quickly evaluated and helping them navigate their way to the right treatment plan and services.
• Many roads to recovery:  Treatment planners and coordinators—be they recovery specialists, county drug and alcohol, centers of excellence, or other medical or community organizations—must develop approaches that fit the realities of their patients’ lives, resources, and illnesses.

The right next step could be starting medication-assisted treatment designed to reduce cravings right there in the ER. Other patients may need detox beds followed by a stay in inpatient rehabilitation. Hospitals and their partners need the resources and flexibility to fashion handoffs that will work for their patients and communities.

A marathon relay, not a sprint

Overcoming addiction is a difficult and lengthy pursuit for patients and the many different kinds of health care professionals who provide treatment. From ER physicians to peer counselors to county authorities to detox and treatment services, we must all hand off the baton quickly and smoothly. That’s how our patients are going to survive and move successfully to next leg of the journey.

Hospital ERs are one place that first handoff can happen.