Looking for a deeper dive in Buprenorphine training? Here are some complimentary educational offerings:

• Between February and August, a series of ten complimentary buprenorphine X-Waiver courses are being made available to all eligible prescribers in Wisconsin. The training, presented by the Wisconsin Society of Addiction Medicine (WISAM) in partnership with Wisconsin DHS, is designed to increase treatment capacity for opioid use disorders in Wisconsin. Learn more and sign up for a course.
• "Buprenorphine 101 Demystifying Medication Assisted Treatment in Wisconsin" is an ED-focused webinar available on demand. View webinar. 
• "Developing an ED Initiated Buprenorphine Program" is an ED-focused webinar available on demand. View webinar. 

Beginning in 2019, the Wisconsin EMS Board has adopted a quarterly meeting schedule. State EMS meetings are open meetings and WACEP members are welcome to attend as members of the general public and/or at the Physician Advisory Committee.

Dr. Aurora Lybeck, WACEP Board member, regularly attends the meetings and encourages additional WACEP participation. Dr. Riccardo Colella, current Wisconsin State Medical Director, and Dr. Steven Zils, chair of the EMS Physician Advisory Committee, are both WACEP members. 

The EMS Board and Committees will meet in 2019 as follows:

• March 5/6
• June 4/5
• September 3/4
• December 3/4

The committees of the Board will meet on the first day (Tuesday) and the full Board will meet on the second day (Wednesday). Links to the Agendas and meeting minutes will be posted when available.

Julie Doniere, MD
WACEP Board of Directors

I know… another article about opiates.  Bear with me, I am writing this because I am anxious to start some conversations about treatment of opiate abuse.  Specifically, I am eager to hear about what is happening in the ED’s across Wisconsin.  

In my practice, I feel like the biggest challenge is finding treatment for those patients that are seeking help with their opiate abuse.  Current practice is often symptomatic treatment, a referral list, and a “good luck!” We see people at their most vulnerable. We are either taking care of them after overdose, identifying their abuse disorder by looking at old charts, or being there when they realize they have a problem and present themselves to the ED. 

There are some caveats to opiate treatment. Opioid addiction does not respond to the same treatments as alcoholism.  Abstinence therapies do not typically work.  These patients have a desperate need to avoid withdrawal. 

This is where buprenorphine can be helpful.  While incorporating bup into my treatment in the ED, I have encountered multiple misconceptions about the drug:

Myth #1: You can’t administer Buprenorphine in the ED without an X-Waiver. 
BUSTED: Any ED physician or midlevel provider can use buprenorphine in the ED to treat opiate withdrawal.  The patient can return to the ED for 3 days In a row to get buprenorphine. 

Myth #2: Buprenorphine is a scary drug and will throw my patient into withdrawal.
BUSTED: Well, kind of busted.  Buprenorphine will cause withdrawal symptoms.  It should be given only to that subset of patients who are already in withdrawal; the COWS scale can measure this, I use MDcalc.  When a patient has a COWS scale of 8 or greater, buprenorphine can be given.

Myth #3: Every opiate addicted patient in the county will be inundating my ED for buprenorphine.
BUSTED: ED’s that have initiated buprenorphine have seen a decline on drug seeking behavior. 

Myth #4: We are trading one addiction for another.
BUSTED: The goal of medical assisted treatment is to trade addiction for dependency.  Abstinence from opiates is the goal.  While buprenorphine is an opiate agonist, it works primarily to control withdrawal symptoms so that individuals have more control over their cravings and avoid the risky use of opiates. 

By no means is this article meant as a fully informative review of buprenorphine in the ED.  I am not smart enough for that!  If you are interested in a deeper dive into the role of buprenorphine in the ED, please view one of these two webinars:

• Developing an ED Initiated Buprenorphine Program (View) 
• Buprenorphine 101 - Demystifying Medication Assisted Treatment in Wisconsin (View)

The following information about ED dosing concepts is thanks to Dr. Donald Stader, an ED doc in Colorado:

In a news feature aired last summer on WEAU Channel 13 in Eau Claire,  new WACEP Board member Nate Blankenheim, MD  was interviewed in an exclusive look inside the new Marshfield Medical Center Eau Claire Emergency Department. Doctor Blankenheim talked with the reporter about the new facility and tried to teach him how to put on a cast. Watch video.

January 17, WMS Medigram

The State of Wisconsin Medical Examining Board modified the Opioid Prescribing Guideline at its monthly meeting in Madison on Wednesday. Expressing a desire to be less proscriptive in the “Discontinuing Opioid Therapy” section of the guideline, the Board has removed specific clinical suggestions for situations when opioid therapy leads to evidence of addiction risk or is proving ineffective.

The section’s first two subsections have been shortened, while the third section remains the same:

Discontinuing Opioid Therapy
a. If lack of efficacy of opioid therapy is determined, safe discontinuation of opioid therapy should be performed.
b. If evidence of increased risk develops, safe discontinuation of opioid therapy should be considered.
c. If evidence emerges that indicates that the opioids put a patient at the risk of imminent danger (overdose, addiction, etc.), or that they are being diverted, opioids should be immediately discontinued and the patient should be treated for withdrawal, if needed. Exceptions to abrupt opioid discontinuation include patients with unstable angina and pregnant patients. These patients should be weaned from the opioid medications in a gradual manner with close follow-up.

The Board also added a new general provision near the top of the overall guideline:

2. It is best practice for a practitioner to consider guidelines within their specialty when prescribing opioids.

The remaining guideline provisions were renumbered to reflect this addition. The new guideline became effective upon Wednesday’s vote approving the changes.

In other action, the MEB elected its leaders for 2019. They are the same as in 2018, with Ken Simons, MD, reelected chair, Tim Westlake, MD, as vice chair and Mary Jo Capodice, DO, as secretary.

Jeffrey Pothof, MD, FACEP
WACEP President

Dear WACEP members,

Thank you for everything you do day in and day out to ensure our communities, our families, and our patients in Wisconsin and beyond have access to great emergency care.  I’m humbled to be your president and commit to working hard to ensure you are supported in your professional practice and that we, collectively, advocate for high quality emergency medical care.

I wanted to take a moment to introduce myself to all of you.  My hope is that during the next year I’ll be able to meet many of you in person through our mutual involvement in the things that matter most to us as emergency physicians.  I grew up in Randolph, a small town in rural Wisconsin.  I attended Edgewood College and subsequently the UW School of Medicine and Public Health for my doctorate degree.  I completed residency at the University of Michigan.  While in Ann Arbor I finished a medical education scholars program in healthcare administration and served as chief resident during my fourth year of residency.

I came back to Madison after residency as faculty at the University of Wisconsin.  I had developed a strong passion in health system operations as well as patient safety and quality while in residency that spilled over into my early professional career.  I held various leadership roles over the last decade including Service Chief of Emergency Medicine for the William S. Middleton VA Hospital, Clinical Service Chief for the UW Division of Emergency Medicine, Vice Chair of Quality and Operation for the UW Department of Emergency Medicine, and most recently a health system role now serving as Chief Quality Officer for UW Health.   I continue to work shifts both at our University Hospital emergency department and at the smaller emergency department at our American Center campus.  I’ve been a flight physician with UW Med Flight for the last 8 years and still enjoy it as much today as I did back then.

My interest in organized medicine began early in my career.  I joined ACEP’s Quality Improvement and Patient Safety Section in 2012.  I served the section in many roles culminating as chair of the section in 2015.  I was also a member of the Quality and Performance Committee from 2013-2017.  More recently my interests have shifted from the national level to the local level.  In 2016 I began serving as a board member for WACEP and have enjoyed working on issues that impact the physicians and patients in my own back yard and being able to represent our interests at the annual ACEP council meeting.

I want to encourage all of you no matter what your background to attend our Spring Symposium.  Registration is currently open and can be found here.  There has been tremendous effort expended by our team to provide a very valuable experience for those in attendance.  I really think all of us no matter our practice environment will take something away from this year’s conference.

I’ll have more updates as we move through the year, but WACEP has its hands in many pots.  We are committed to being good partners in the fight against the opioid crisis.  We are devoted to improving both the patient and provider experience when it comes to navigating our mental health system.  We are eager to develop initiatives to assist providers in finding meaning in their work, and we continue to advocate for fair Medicaid reimbursement for the care you deliver.   My hope for this year is that we become closer as physicians who provide emergency care without any additional qualifiers.  Whether in democratic groups, national group practices, small rural practices, or large academic practices there is more that holds us together than pulls us apart.

I’m excited to embark on this journey with you and look forward to WACEP’s accomplishments in 2019.

Sincerely,

Jeff

Jamie Schneider, MD
EM3, MCW Emergency Medicine Residency
WACEP Alternate Delegate to WMS and ACEP

As the end of residency nears I have noticed a subtle shift in my education. Until recently, I had been focused on how to treat patients; medical school taught me disease and diagnosis and the broad strokes, and the first years of residency honed my treatment of crashing patients and worried well.

It’s only in the last year that I’ve really started learning what it means to be a physician in the real world.  This includes billing workshops, applying for jobs, reviewing contracts, and engaging in philosophical discussions on management of our profession.

To this end, I had the awesome opportunity to join the WACEP delegation at the ACEP 2018 Annual Meeting last fall as an alternate delegate. Where the ACEP Scientific Assembly adds to our education and tools for treating patients, the Annual Meeting gives us a venue to shape the practice and profession of Emergency Medicine.

ACEP, as with seemingly every other organization in America, spent much of its time at the Annual Meeting on opioids. Just as interesting, however, was the vast amount of discussion about what Emergency Medicine is, and how we as a profession should manage and advance it. We heard keynotes on how to tackle the lack of trained EPs in rural areas, bylaws amendments on who should be a part of ACEP, and resolutions on topics from protecting physicians’ mental and physical health to ensuring fair and appropriate remuneration to appropriately training future EPs.

As a physician early in my career, these debates were valuable in shaping my understanding and views, and for our more experienced members gave a forum for sharing their wisdom. It can be argued that Emergency Medicine attracts one of the most diverse groups of practitioners, caring for the most diverse group of patients in the most diverse environments in all of medicine. There is clearly no “one best way” forward for our profession, but forums like the ACEP Annual Meeting are invaluable for allowing us to find common ground.

With that in mind, I am looking forward to the Wisconsin Medical Society’s Annual Meeting coming up on April 7. Representatives from each Wisconsin specialty society (including WACEP) and from all geographic districts of the state will gather in Madison to discuss topics relevant to the entire house of medicine of Wisconsin. Resolutions this year will include at least two that are sponsored by WACEP. If you don’t happen to be sleeping off a Saturday overnight shift, consider joining us for what is sure to be interesting and enlightening discussion.

ATTENTION MEDICAL STUDENTS! If you're considering Emergency Medicine for residency the April 13th Midwest Medical Student Emergency Medicine Symposium is for you!

We know the residency match process can be overwhelming. That's why Wisconsin-ACEP is teaming up with the MCW and UW Emergency Medicine Residency Programs to co-sponsor the event alongside Ohio and Michigan Chapters of ACEP, EMRA, and some of the top residency programs from around the country.

This event will show medical students the ropes on choosing the right residency, rocking your interview, and standing out from the competition! Don't miss out on this one-of-a-kind event with a dynamic agenda designed to maximize your participation.    

Midwest Med Student Symposium & Residency Fair

April 13, 2019
Hilton Garden Inn Toledo/Perrysburg, Ohio

Learn more and register online. Registering by phone? Call Monday-Friday, 1-888-642-2374 between 7am and 4pm CST.

A recent article in the USA Today quoted WACEP leader Bobby Redwood, MD, MPH, FACEP, and highlighted over a year of work being done by Wisconsin ACEP, the Wisconsin Hospital Association, and other organizations in regards to initiating Medication Assisted Treatment (Buprenorphine), in the Emergency Department.

Redwood points out a few of the efforts to date: 1) WACEP surveyed the EM workforce in Wisconsin on MAT; 2) WACEP developed an infographic on MAT & the ED; 3) WACEP and other organizations scheduled and promoted X-waiver training opportunities in Wisconsin; and 4) WHA developed a webinar to encourage MAT cooperation between primary care and emergency physicians.

WACEP's next steps are to work with key stakeholders to secure funding and develop regional streamlined care processes to make sure patients get the coordinated care they need.

"While WACEP will continue its efforts in 2019," says Redwood, "I am really hopeful that we will start to stem the tide of morbidity and mortality from opioid overdoses in Wisconsin. Thanks to all who contributed to this important work."

A monthly webinar series, Health Care Workforce Resilience, jointly sponsored by the Wisconsin Medical Society and the Wisconsin Hospital Association, is offered the second Tuesday of each month throughout 2019.

Each month will focus on a unique topic. Participants will receive one hour of continuing education credit, as well as practical and easy-to-implement tools for dealing with burnout in health care.

Resources and the recording of the January webinar, Prevalence & Severity of Burnout: Workforce Resilience as Care Quality, are available online.

 The next monthly webinar, Enhancing Resilience: The Science and Practice of Gratitude, will occur on February 12 and will demonstrate a simple, enjoyable and effective tool for improving well-being by cultivating gratitude. Learn more and register.