Abstract
Objective
The objective of this study was to assess opioid use in an emergency department following
the development and implementation of an alternative to opioids (ALTO)-first approach
to pain management. The study also assessed how implementation affected patient satisfaction
scores.
Methods
This study compared data collected from October to December of 2015 (prior to implementation)
to data collected between October and December of 2016 (after the intervention had
been implemented). Emergency department visits during the study timeframe were included.
Opioid reduction was measured in morphine equivalents (ME) administered per visit.
Secondary outcomes on patient satisfaction were gathered using the Press Ganey survey.
Results
Intravenous (IV) opioid administration during the study period decreased by >20%.
The predicted mean ME use in 2016 was 0.25 ME less when compared to 2015 (95% CI −0.27
to −0.23). Estimated use for patients in the pre-implementation period was 1.45 ME
mgs (SD 0.88), and 1.13 ME mg (SD 0.69) for patients in the post-implementation period.
Patient satisfaction scores using the Press Ganey Scale also were assessed. There
was no significant difference in the scores between 2015 and 2016 when patients were
asked “How well was you pain controlled?” (−0.94, 95% CI −5.29 to 3.4) and “How likely
are you to recommend this emergency department?” (−1.55, 95% CI −5.26 to 2.14).
Conclusion
In conclusion, by using an ALTO-first, multimodal treatment approach to pain management,
participating clinicians were able to significantly decrease the use of IV opioids
in the emergency department. Patient satisfaction scores remained unchanged following
implementation.
Keywords
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Article Info
Publication History
Published online: April 21, 2018
Accepted:
April 19,
2018
Received in revised form:
April 16,
2018
Received:
February 28,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
