Turning Research into Advocacy
Working in the emergency department (ED) is an incredibly rewarding and stimulating career. We see it all from sprained fingers to pneumonia to major trauma. One thing that became obvious to me working in an inner city hospital was that many of our patients were dealing with severe substance use disorders and extreme social inequity. In combination, these things made it difficult for our some of our patients to regularly engage in primary health care or get access to any health care services aside from when they had a medical crisis.
In addition to what I was seeing in the ED, I was also very interested in resident wellness and how we could keep ourselves happy and healthy despite the demands of a medical career. Getting a CAEP grant early in my career to evaluate the effect of a mentorship program for emergency medicine residents allowed me to really develop my research skills and laid the foundation for being successful in larger grant competitions (Evaluation of a Resident Wellness Curriculum for Emergency Medicine Requests). It also enabled me to connect with some incredible research mentors who provided invaluable advice and guidance.
Today I run the Inner City Health and Wellness Program, a three-year pilot program funded by the Royal Alexandra Hospital Foundation. Part of this program is the Addiction Recovery and Community Health (ARCH) Team, a specialty consult service that is available to admitted inpatients and ED patients. This team consists of an addiction medicine physician, nurse practitioner, social worker, addiction counselor and, soon, a peer support worker. We provide evidence-based recommendations for the treatment of any substance use disorder, initiate or maintain opioid agonist treatments, perform health promotion interventions (blood borne virus, sexually transmitted infections screening), educate patients about overdose prevention (including naloxone training), and provide aggressive social stabilization via brokered access to housing, income supports, identification and primary care. We have been able to assemble an incredible research team who will be able to tell us how this type of intervention has affected, most importantly, the health of our highest risk patients, but also health system costs.
Having a strong foundation of research skills has been critically important in my ability to advocate for change in how the health care system interacts with some of the sickest and most at-risk patients we see in the ED. My involvement in CAEP through research, as well as the networking opportunities and exposure to different ways of thinking that occur when you are part of a national organization, have been pivotal. What if we could identify patients at high risk of morbidity due to substance use or poor social determinants of health on their first ED visit and aggressively intervene before they ended up in the trauma bay 5, 10 or 50 ED visits later? That is the question I hope to answer.
Inner City Health and Wellness Program, as featured on the Shaw Road to Hope series: