Supported by the State Opioid Response Grant through the West Virginia Department of Health and Human resources, Ruby Memorial Hospital is the first ED in West Virginia to implement the IMPACT model: Initiating Medication, Peer Assistance, Connection to Treatment. After reviewing research showing better outcomes for patients who received Buprenorphine in the ED including increased engagement in addiction treatment, reduced illicit opioid use and decreased use of high resource inpatient treatment services, Ruby Memorial Hospital launched the IMPACT model in March 2020. The IMPACT model highlights the need for patient support in the ED to successfully bridge to treatment and follow patients long-term. Peer recovery support specialists, individuals with lived experience in long-term recovery, are providing this level of connection and support. The model encourages the induction of Buprenorphine in the ED or providing a 1-3 day take home prescription if clinically indicated followed by inpatient or outpatient medication assisted treatment through a behavioral health provider.
Laura Lander, licensed social worker and associate professor with West Virginia University’s Department of Behavioral Medicine and Psychiatry and Neuroscience, has worked diligently to implement the IMPACT model and keep it working effectively. In accordance to the model, Ruby Memorial Hospital employs two full-time and two part-time peer recovery support specialists from 9am-11pm. The peer recovery support specialists are hospital employees and have access to the hospital’s electronic health records where they are given a track board populated by a patient’s chief complaint, opioid screening question, or the Clinical Opioid Withdraw Scale (COWS) score. The Peer Recovery support specialists serve as a repository for recovery resources and work to link identified patients to next day outpatient care or a higher level of care if clinically necessary.
“Having peers in the ED is an example of how people can be successful in recovery. ED staff normally do not get to see what happens to the patients they treat post ED visit. Peers give staff hope. Simultaneously, our peer recovery support specialists provide site support to the nursing staff by de-escalating situations and making patients feel like they are ‘seen’ and not ignored especially those in active withdrawal. Our peer recovery support specialists make them feel like they have an advocate and a support system,” Lander explained.
Once the peer recovery support specialist links the patient to treatment, the peer recovery coach remains accessible to the patient via telecommunication even after they enter outpatient treatment if they remain in the WVU Medicine system or provide a warm hand off to another peer recovery coach within the treatment setting.
While inducing Buprenorphine in the ED can be done without a DEA X-Waiver, Ruby Memorial Hospital ED has almost 75% of their physicians waivered. The proven outcomes of MOUD in the ED and the increased number of patients successfully attending outpatient appointments post ED induction has encouraged provider participation. If the patient has a COWS score greater than 10, the patient is referred for Buprenorphine in the ED. Un-waivered providers can only give doses to a patient in the ED. Waiver providers can write a take home prescription in order to help the patient manage withdrawal until the patient is linked to outpatient care. A take home prescription can be given by the hospital consult team if the ED provider is not waivered.
While many hospitals have concerns about the efficacy of peers in the ED and the induction of Buprenorphine, Ruby Memorial Hospital has found the combination to be successful in increasing engagement in addiction treatment with the ultimate goal of saving lives.
If your facility is interested in learning more about the IMPACT model and how to become engaged in the process, please contact Laura Lander at 304-293-3965.