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
To read this article in full you will need to make a payment
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments.JAMA. 2008; 299 (70–8)
- Opioid-prescribing patterns of emergency physicians and risk of long-term use.N Engl J Med. 2017; 376: 663-673
- Early opioid prescription and subsequent disability among workers with back injuries: the disability risk identification study cohort.Spine. 2008; 33: 199-204
- Results from the 2014 National Survey on Drug Use and Health: detailed tables.
- Why doctors prescribe opioids to known opioid abusers.N Engl J Med. 2010; 367: 1580-1581
- Drug Abuse Patterns and Trends in Colorado and the Denver/Boulder Metropolitan Area — Update.National Institute on Drug Abuse, 2014
- Wide-ranging Online Data for Epidemiologic Research (WONDER).CDC, National Center for Health Statistics, Atlanta, GA2016 (Available at)
- Heroin use and heroin use risk behaviors among nonmedical users of prescription opioid pain relievers — United States, 2002–2004 and 2008–2010.Drug Alcohol Depend. 2013; 132: 95-100
- Pain management: association with patient satisfaction among emergency department patients.J Emerg Med. 2014; 46: 456-464
- “Pressure to prescribe” the impact of economic and regulatory factors on South-Eastern ED physicians managing the drug seeking patient.J Emerg Trauma Shock. 2016; 9: 58-63
- Opioid painkiller prescribing.
- Geographic variation in opioid and heroin involved drug poisoning mortality rates.Am J Prev Med. 2017; https://doi.org/10.1016/j.amepre.2017.06.009
- Washington emergency department opioid prescribing guidelines.
- Oregon emergency department (ED) opioid prescribing guidelines.
- Clinical policy: critical issues in the prescribing of opioids for adult patients in the emergency department.Ann Emerg Med. 2012; 60: 499-525
- Policy for prescribing and dispensing opioids.(wisc.edu/files/Colorado_Joint%20Bd_Policy%20for%20Prescribing%20and%20Dispensing%20Opioids.pdf)
- Guideline for prescribing opioids for chronic pain.
- Development of an opioid reduction policy in the emergency department.Am J Health-Syst Pharm. 2015; 72: 2080-2086
- St. Joseph's announces innovative ALTO program.
- Alternatives to Opioids for Acute Pain management in the Emergency Department: Part I.AHC Media, October 2016
- Predictors of patient satisfaction with pain management in the emergency department.Adv Emerg Nurs J. 2016; 38: 115-122
- Addiction rare in patients treated with narcotics.N Engl J Med. 1980; 302: 123
- Chronic use of opioid analgesics in non-malignant pain: report of 38 cases.Pain. 1986; 25: 171-186
- Pain as the fifth vital sign.1. Geriatrics and Extended Care Strategic Healthcare Group, October 2000: 1-57
- Opioid prescribing and treatment guidelines.
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.