Pomona Valley Hospital Medical Center is a busy 412-bed, full-service hospital serving a sprawling, socially, ethnically and economically diverse urban community stretching between eastern Los Angeles and western San Bernardino counties.
Like many urban areas, Pomona has a significant homeless population and people with high rates of addiction and substance use disorders who end up among the 90,000 patients in the hospital’s hectic Emergency Department (ED) each year.
Always looking to improve services and realizing that ED care is expensive as well as often less equipped to address chronic issues, such as mental health and substance abuse, Dr. James Kim, medical director of the ED, and Angela Besiant, the ED’s director of nursing, reached out to Dr. Bharath Chakravarthy, regional director for the CA Bridge program, to explore better treatment options for these patients.
“A year ago, when I first talked to Dr. Kim and Angela Besiant, the hospital didn’t have a single provider with the necessary X-waiver to treat patients with substance use disorders,” says Dr. Chakravarthy. He introduced the ED staff to the CA Bridge program at one of their staff meetings and came away confident that, with resources and support, they’d be able to successfully implement the CA Bridge model.
“They had a mature understanding of the problem and a commitment. They asked all the right questions.” Less than a year later, the CA Bridge model was launched at the hospital.
Sherrie Cisneros, a registered nurse who has worked in nearly every hospital department over her 25-year career, was brought on as the Substance Use Navigator to launch the new effort.
“I’ve learned to be more flexible and appreciate patients accomplishing small goals. The day a patient told me that he took our medicine, instead of going to his dealer, was huge.”
Today, 14 out of 40 ED providers, at least one person on every shift, is X-waivered to provide Medication for Addiction Treatment (MAT). Now all high-risk patients receive Narcan nasal spray when they’re discharged in case they overdose, and Cisneros is able to refer patients for ongoing treatment. The result is available 24/7 evidence-based care for anyone who comes to the ED.
As a nurse, who is used to giving orders and having patients follow them, she says, “This is different from my other nursing experiences. It made me realize my own prejudices. I’ve learned to be more flexible and appreciate patients accomplishing small goals. The day a patient told me that he took our medicine, instead of going to his dealer, was huge.”
Even in the short time since implementing the CA Bridge model and then going into COVID-19 lockdown a week later, she has accumulated numerous success stories. She tells about a 21-year old scholarship student who became addicted to drugs he was prescribed after an accident. When he couldn’t get a new prescription, he started looking for illegal drugs. Bad street drugs put him in the hospital for two days with acute kidney failure. He was referred to her, and she arranged for him to get MAT. Now he’s back in school and working to prioritize a healthier lifestyle.
Cisneros says she loves making rounds with the doctors and nurses every day in the ED. “I remind them that I’m here and ask if they have patients to refer to me. I follow up and let the doctors know what happened to any patients they refer. I love being part of the solution.”
Sherrie Cisneros is now the Substance Use Navigator Director at CA Bridge. Because she’s implemented the CA Bridge model in the hospital setting, she knows first-hand the proven benefits for staff and patients, which informs her statewide leadership supporting all Substance Use Navigators. Check out upcoming Substance Use Navigator (SUN) training opportunities to learn more.