Learning about Opioid Use Disorder (LOUD) in the Emergency Department (ED) was a provincial quality improvement initiative focused on ED care for people who use opioids. We led this initiative in partnership with the Overdose Emergency Response Centre and the BC Center on Substance Use to shift how emergency departments care for people who use opioids.

This virtual Action Series included a combination of virtual learning, coaching, networking and local improvement actions from October 2020 – March 2021. Twenty-five teams from across the province engaged in learning and application of change ideas related to clinical practice, education, person- and provider-centred care and connections to the community. Participating teams also engaged with each other to share new learning and insights from their local improvement work. We are now delivering a second iteration of LOUD in the ED in the summer of 2024 – 2025— learn more now!

Check out some of the informative resources below to guide you and your team on your improvement journey!

Getting Started

This resources page is full of links, documents and online training to support your quality improvement journey to improve OUD care in the ED. In consultation with the LOUD in the ED Faculty, four main drivers for improvement were identified and each Action Period focuses on one of those drivers. Read the full LOUD in the ED driver diagram or click on any Action Periods below to see all related recordings and resources.

Action Periods

LOUD in the ED Action Period 1: Recommended Clinical Decision Support Tools

Implementing recommended practices to inform order sets and guideline development. There is a wide variety of emerging research around buprenorphine-naloxone starts in the ED. We have included a collection of identified resources, Pre Printed Orders (PPOs) and guidelines by our provincial expert faculty to help guide you in making informed decisions for people with OUD…
Learn More LOUD in the ED Action Period 1: Recommended Clinical Decision Support Tools

LOUD in the ED Action Period 3: People- and Provider-Centred Care

Stigma, engagement and access. People with OUD’s long-term relationship with the health care system, as well as their experiences accessing care and treatment, is often dictated by the nature of their first experience with the ED. Having a better understanding of trauma-informed practice, early identification and better clinical understanding of what OUD care looks like…
Learn More LOUD in the ED Action Period 3: People- and Provider-Centred Care

Opioid Use Disorder Care in the Emergency Department Webinars

Co-presented by us and the British Columbia Centre on Substance Use, this series of care-based discussions explored ways to enhance care experiences for the treatment of people with opioid use disorder in the emergency department.

To help support busy emergency department care providers, check out preparatory online material with some of the foundations to providing quality care.

Just the Nuggets

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Buprenorphine/Naloxone in the Emergency Department

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Not Just Naloxone: Advancing a First Nations Perspective

Creating Safer Care Experiences

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Learning about Opioid Use Disorder LOUD in the Emergency Department ED Cover

Learning About Opioid Use Disorder (LOUD) in the Emergency Department (ED) Final Report 2020/21

Learning about Opioid Use Disorder (LOUD) in the Emergency Department (ED) was a provincial initiative led in partnership between us, BC Centre on Substance Use and Overdose Emergency Response Centre with EDs across BC. This quality improvement initiative aimed to shift how EDs care for individuals with OUD. In the context of dual public health…
Read the Report Learning About Opioid Use Disorder (LOUD) in the Emergency Department (ED) Final Report 2020/21

Language Matters

This interview was recorded with Andrew Kestler, Britt-Heidi Bailey, & Reija Jean (Peer Advocate & Vice-President BCAPOM), with support from the BC Patient Safety & Quality Council & LOUD in the ED.

Watch the full interview (18 min) with Reija and Britt or jump to:

Additional Tools & Resources

General OUD Care Resources

General Quality Improvement Resources

Culture Change Toolbox
A collection of tools and interventions for changing culture, each one accompanied by tips on how to apply it.

ATTIC: Activities for Transforming Teams & Igniting Change
ATTIC is a collection of activities that you and your team can use to build teamwork, develop communication skills, enable creative thinking and innovation, and help explore systems.

A Guide to Patient Engagement
This BCPSQC resource covers the essentials of patient engagement, how to prepare for it, where you can find patient partners and how to engage them. 

Substance Use & COVID-19

Substance Use & COVID-19 Resources Check out this collection of resources for people who use drugs, providers and more collated by the BC Centre on Substance Use.

Risk Mitigation in the Context of Dual Public Health Emergencies This protocol is intended to provide clinical guidance to health care providers to support patients in the context of the COVID-19 pandemic and overdose crisis.

Ted Talk: Is Safe Supply a Viable Option for the Overdose Crisis? Guy Felicella advocates for harm reduction on behalf of British Columbia’s Overdose Emergency Response Centre, Vancouver Coastal Health’s Regional Addiction Team and the British Columbia Centre on Substance Use. He is also a LOUD in the ED Faculty member.

New Plan G Bridge Coverage & Applications

Plan G Bridge Coverage is now available to provide patients with faster, temporary Plan G coverage. Practitioners in emergency departments (EDs), Rapid Access Addiction Clinics (RAACs), urgent primary care centres (UPCCs), and correctional centres (both provincial and federal) can apply for Plan G bridge coverage, using a new section of the Plan G form. Practitioners can then send the form directly to Health Insurance BC instead of a mental health and substance use centre.

Plan G bridge coverage is provided to patients for 3 months, during which, to continue coverage, patients are to see a practitioner in their community to apply for regular Plan G coverage. This new process should provide patients who need immediate Plan G coverage with the coverage they need, and enough time to connect with a prescriber in the community to apply for regular Plan G coverage.

The new Plan G Application Form (to be used for regular, exceptional, and bridge Plan G coverage) is now available

Download Now

A guide to Applying for Plan G Bridge Coverage to help explain the bridge coverage application process is available here.

Download Now

Frequently Asked Questions

LOUD in the ED stands for Learning about Opioid Use Disorder in the Emergency Department. The name was chosen to encourage discussion and awareness about opioid use disorder (OUD) and to impact the quality and accessibility of OUD services in local emergency departments (EDs).

LOUD in the ED is a provincial initiative led by Health Quality BC in partnership with the Overdose Emergency Response Center and the BC Centre on Substance Use. Twenty-five teams will participate in a virtual action series from October 2020 to February 2021. During the initiative teams can expect the following:

LOUD in the ED aimed to improve the experience of OUD care for people and providers, and to reduce the morbidity and mortality for people with OUD in the ED by improving access to evidence-informed care. This includes access to buprenorphine-naloxone (Suboxone®).

The LOUD in the ED action series began in October 2020 and ended in March 2021.

Action Period 1

Learning Session 1: Recommended Clinical Decision SupportTuesday, October 6 @ 0800-1130
Coaching Call: Case StudyWednesday, October 21 @ 1000-1100
Coaching Call: Pharmacy & MicrodosingWednesday, October 28 @ 1330-1430

Action Period 2

Learning Session 2: Clinical Education & StrategiesThursday, November 5 @ 1100-1200
Coaching Call: Education StrategiesMonday, November 16 @ 1200-1300
Coaching Call: PPO Case StudyWednesday, November 24 @ 1000-1100

Action Period 3

Learning Session 3: Person- and Provider-Centred CareTuesday, December 1 @ 1200-1300
Coaching Call: Case Study – EQUIP in ActionWednesday, December 9 @ 1500-1600
Coaching Call: Communication & Community PrescribingTuesday, December 15 @ 1400-1500

Action Period 4

Learning Session 4: Connection ContinuumThursday, January 14 @ 0800-1130
Coaching Call: Remote/Rural versus Urban Perspectives on Transitions of CareThursday, January 28 @ 1200-1300

Action Period 5

Wrap Up & CelebrationWednesday, February 10 @ 1200-1300

Twenty-one percent of people with OUD have their first point of contact with the health care system in the ED – there is never a second chance to make a first impression. The ED setting provides a unique opportunity to connect with people who use drugs and intervene early. Many ED teams experience the effects of OUD on a daily basis and this initiative supported teams to provide evidence-based, quality care.

Applying best practice for people with OUD in the ED improves patient care and has the potential to reduce length of stay, readmission rates, and workload and burnout for staff.

Teams benefited from focused support, the opportunity to collaborate with, and learn from, other teams from across the province, and quality improvement training that can be applied to all areas of care you provide.

The LOUD in the ED Action Series combined opportunities for learning and networking with opportunities to apply change ideas at local sites. This included:

  • Five interactive webinars to teach and highlight tools for improving care in your ED;
  • Action periods following each webinar during which teams worked together to explore application of the new tools and translate ideas into practice;
  • Coaching calls to support team improvement efforts.

PWLLE are integral members and leaders in both the planning and action stages of the collaborative. Some of the faculty members were PWLLE, and additional PWLLE are being engaged in the development of resources and education. Participating teams were encouraged to have a PWLLE as part of their core team membership.

Please contact the LOUD in the ED project team at loud@healthqualitybc.ca.