Effect of A "no Superuser Opioid Prescription" Policy on ED visits and statewide opioid prescription

Zachary P. Kahler, Paul Musey, Jason Schaffer, Annelyssa N. Johnson, Christian C. Strachan, Charles Shufflebarger

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Introduction: The U.S. opioid epidemic has highlighted the need to identify patients at risk of opioid abuse and overdose. We initiated a novel emergency department- (ED) based interventional protocol to transition our superuser patients from the ED to an outpatient chronic pain program. The objective was to evaluate the protocol's effect on superusers' annual ED visits. Secondary outcomes included a quantitative evaluation of statewide opioid prescriptions for these patients, unique prescribers of controlled substances, and ancillary testing. Methods: Patients were referred to the program with the following inclusion criteria: ≥ 6 visits per year to the ED; at least one visit identified by the attendi ng physician as primarily driven by opioid-seeking behavior; and a review by a committee comprising ED administration and case management. Patients were referred to a pain management clinic and informed that they would no longer receive opioid prescriptions from visits to the ED for chronic pain complaints. Electronic medical record (EMR) alerts notified ED providers of the patient's referral at subsequent visits. We analyzed one year of data pre- and post-referral. Results: A total of 243 patients had one year of data post-referral for analysis. Median annual ED visits decreased from 14 to 4 (58% decrease, 95% CI [50 to 66]). We also found statistically significant decreases for these patients' state prescription drug monitoring program (PDMP) opioid prescriptions (21 to 13), total unique controlled-substance prescribers (11 to 7), computed tomography imaging (2 to 0), radiographs (5 to 1), electrocardiograms (12 to 4), and labs run (47 to 13). Conclusion: This program and the EMR-based alerts were successful at decreasing local ED visits, annual opioid prescriptions, and hospital resource allocation for this population of patients. There is no evidence that these patients diverted their visits to neighboring EDs after being informed that they would not receive opioids at this hospital, as opioid prescriptions obtained by these patients decreased on a statewide level. This implies that individual ED protocols can have significant impact on the behavior of patients.

Original languageEnglish (US)
Pages (from-to)894-902
Number of pages9
JournalWestern Journal of Emergency Medicine
Volume18
Issue number5
DOIs
StatePublished - Aug 1 2017

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Opioid Analgesics
Prescriptions
Hospital Emergency Service
Referral and Consultation
Controlled Substances
Electronic Health Records
Chronic Pain
Pain Clinics
Prescription Drugs
Resource Allocation
Drug Monitoring
Case Management
Advisory Committees
Pain Management
Electrocardiography
Outpatients
Tomography
Physicians

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Effect of A "no Superuser Opioid Prescription" Policy on ED visits and statewide opioid prescription. / Kahler, Zachary P.; Musey, Paul; Schaffer, Jason; Johnson, Annelyssa N.; Strachan, Christian C.; Shufflebarger, Charles.

In: Western Journal of Emergency Medicine, Vol. 18, No. 5, 01.08.2017, p. 894-902.

Research output: Contribution to journalArticle

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