No Wrong Door: Bridging Continuity of Care in Addiction Treatment

The staff of the Brigham health bridge to recovery clinic

In the face of America’s growing opioid crisis, Brigham and Women’s Hospital has introduced an innovative new service to help patients with addiction abuse disorder get the immediate care they need. Opened in spring 2018, the Bridge Clinic immediately connects patients being discharged from the hospital and emergency department with treatment and services.

“For decades, the standard health system approach to addiction treatment has been fragmented,” said Joji Suzuki, MD, who is a clinical supervisor of the clinic along with colleague David F. Gitlin, MD. “Hospitals would focus on the acute treatment of these patients to stabilize them, but then leave them to their own devices to follow up. Upon discharge from the ER or hospital, the patient typically would be given a list of clinics or community resources to call but often would run into significant wait times to be seen.”

“We would never do that for a cancer patient, so why should patients with the disease of addiction be treated any differently?” asked Dr. Suzuki, who is also director of Division of Addiction Psychiatry at the Brigham. “At no time do we want these patients to have to figure things out on their own. That is no longer an acceptable approach.”

The Brigham’s Bridge Clinic offers a seamless approach to patient care. It provides an immediate option for addiction treatment medications and psychosocial services, with a no-appointment-needed open door, much like urgent care centers.

“Our philosophy is that there is no wrong door for a patient to enter to receive addiction recovery treatment,” said Dr. Suzuki. “Whether they present to their primary care doctor, community health center, ER or the hospital medical floor, they can get comprehensive recovery services at the Bridge Clinic without any barriers to entry. In fact, we can physically walk a patient right from the ER to the clinic to make sure they get the care they need.”

The multidisciplinary team at the clinic includes addiction psychiatrists, primary care physicians, hospitalists and specialists in infectious disease. Buprenorphine and extended-release naltrexone are available, along with recovery coaching.

For patients with opioid use disorder with infectious complications caused by injection drug use, such as endocarditis or osteomyelitis, at-home antibiotic therapy is made possible under certain conditions.

“Because people who inject drugs are typically not candidates for a PICC line, they previously needed long-term inpatient stays in the hospital to receive IV antibiotics to combat the infection,” said Dr. Suzuki. “By keeping patients fully engaged with the Bridge Clinic, taking medication treatment such as buprenorphine or methadone, and conducting regular toxicology testing, patients now are able to successfully complete their course of antibiotics at home.”

“These patients do well on outpatient parenteral antibiotic therapy, and they are grateful for the opportunity to stay out of the hospital,” he said, noting that this strategy helped the Brigham save about 300 inpatient days in the first seven months of the Bridge Clinic’s operation. “We also are able to cut down on behavioral disruptions on inpatient floors and reduce overall health care costs.”

According to Dr. Suzuki, the Bridge Clinic’s success reflects the Brigham’s larger commitment to providing safe, timely and evidence-based treatment for substance use disorder. As an example, he pointed to the Brigham Comprehensive Opioid Response and Education (B-CORE) program chaired by Scott G. Weiner, MD, MPH, which has created task forces to focus on issues around opioid prescribing and addiction treatment.

“The Brigham has always had very strong inpatient and outpatient programs, but the clinic is a real game-changer,” Dr. Suzuki said. “It wouldn’t be possible if the Brigham did not take true responsibility and ownership of this serious health issue from a system level.”

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