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Pragmatic Emergency Department Intervention Reducing Default Quantity of Opioid Tablets Prescribed
The opioid epidemic is a major cause of morbidity and mortality in the United States. Prior work has shown that emergency department (ED) opioid prescribing can increase the incidence of opioid use disorder in a dose-dependent manner, and systemic changes that decrease default quantity of discharge...
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| Published in: | The western journal of emergency medicine 2024-07, Vol.25 (4), p.449-456 |
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| container_end_page | 456 |
| container_issue | 4 |
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| container_title | The western journal of emergency medicine |
| container_volume | 25 |
| creator | Gotham Johnson, Drake Lu, Alice Y Kirn, Georgia A Trepka, Kai Ayana Day, Yesenia Yang, Stephen C Montoy, Juan Carlos C Juarez, Marianne A |
| description | The opioid epidemic is a major cause of morbidity and mortality in the United States. Prior work has shown that emergency department (ED) opioid prescribing can increase the incidence of opioid use disorder in a dose-dependent manner, and systemic changes that decrease default quantity of discharge opioid tablets in the electronic health record (EHR) can impact prescribing practices. However, ED leadership may be interested in the impact of communication around the intervention as well as whether the intervention may differentially impact different types of clinicians (physicians, physician assistants [PA], and nurse practitioners). We implemented and evaluated a quality improvement intervention of an announced decrease in EHR default quantities of commonly prescribed opioids at a large, academic, urban, tertiary-care ED.
We gathered EHR data on all ED discharges with opioid prescriptions from January 1, 2019-December 6, 2021, including chief complaint, clinician, and opioid prescription details. Data was captured and analyzed on a monthly basis throughout this time period. On March 29, 2021, we implemented an announced decrease in EHR default dispense quantities from 20 tablets to 12 tablets for commonly prescribed opioids. We measured pre- and post-intervention quantities of opioid tablets prescribed per discharge receiving opioids, distribution by patient demographics, and inter-clinician variability in prescribing behavior.
The EHR change was associated with a 14% decrease in quantity of opioid tablets per discharge receiving opioids, from 14 to 12 tablets (
= |
| doi_str_mv | 10.5811/westjem.18040 |
| format | article |
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We gathered EHR data on all ED discharges with opioid prescriptions from January 1, 2019-December 6, 2021, including chief complaint, clinician, and opioid prescription details. Data was captured and analyzed on a monthly basis throughout this time period. On March 29, 2021, we implemented an announced decrease in EHR default dispense quantities from 20 tablets to 12 tablets for commonly prescribed opioids. We measured pre- and post-intervention quantities of opioid tablets prescribed per discharge receiving opioids, distribution by patient demographics, and inter-clinician variability in prescribing behavior.
The EHR change was associated with a 14% decrease in quantity of opioid tablets per discharge receiving opioids, from 14 to 12 tablets (
= <.001). We found no statistically significant disparities in prescriptions based on self-reported patient race (
= 0.68) or gender (
= 0.65). Nurse practitioners and PAs prescribed more opioids per encounter than physicians on average and had a statistically significant decrease in opioid prescriptions associated with the EHR change. Physicians had a lesser but still significant drop in opioid prescribing in the post-intervention period.
Decreasing EHR defaults is a robust, simple tool for decreasing opioid prescriptions, with potential for implementation in the 42% of EDs nationwide that have defaults exceeding the recommended 12-tablet supply. Considering significant inter-clinician variability, future interventions to decrease opioid prescriptions should examine the effects of combining EHR default changes with targeted interventions for clinician groups or individual clinicians.</description><identifier>ISSN: 1936-9018</identifier><identifier>ISSN: 1936-900X</identifier><identifier>EISSN: 1936-9018</identifier><identifier>DOI: 10.5811/westjem.18040</identifier><identifier>PMID: 39028229</identifier><language>eng</language><publisher>United States: Department of Emergency Medicine, University of California, Irvine School of Medicine</publisher><subject>Adult ; Analgesics, Opioid - therapeutic use ; Behavioral Health ; Drug Prescriptions - statistics & numerical data ; Electronic Health Records ; Emergency Service, Hospital ; Female ; Humans ; Male ; Middle Aged ; Opioid-Related Disorders - prevention & control ; Practice Patterns, Physicians' - statistics & numerical data ; Quality Improvement ; Substance Use Disorder: Original Research ; United States</subject><ispartof>The western journal of emergency medicine, 2024-07, Vol.25 (4), p.449-456</ispartof><rights>2024 Johnson et al. 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11254152/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11254152/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,37013,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39028229$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gotham Johnson, Drake</creatorcontrib><creatorcontrib>Lu, Alice Y</creatorcontrib><creatorcontrib>Kirn, Georgia A</creatorcontrib><creatorcontrib>Trepka, Kai</creatorcontrib><creatorcontrib>Ayana Day, Yesenia</creatorcontrib><creatorcontrib>Yang, Stephen C</creatorcontrib><creatorcontrib>Montoy, Juan Carlos C</creatorcontrib><creatorcontrib>Juarez, Marianne A</creatorcontrib><title>Pragmatic Emergency Department Intervention Reducing Default Quantity of Opioid Tablets Prescribed</title><title>The western journal of emergency medicine</title><addtitle>West J Emerg Med</addtitle><description>The opioid epidemic is a major cause of morbidity and mortality in the United States. Prior work has shown that emergency department (ED) opioid prescribing can increase the incidence of opioid use disorder in a dose-dependent manner, and systemic changes that decrease default quantity of discharge opioid tablets in the electronic health record (EHR) can impact prescribing practices. However, ED leadership may be interested in the impact of communication around the intervention as well as whether the intervention may differentially impact different types of clinicians (physicians, physician assistants [PA], and nurse practitioners). We implemented and evaluated a quality improvement intervention of an announced decrease in EHR default quantities of commonly prescribed opioids at a large, academic, urban, tertiary-care ED.
We gathered EHR data on all ED discharges with opioid prescriptions from January 1, 2019-December 6, 2021, including chief complaint, clinician, and opioid prescription details. Data was captured and analyzed on a monthly basis throughout this time period. On March 29, 2021, we implemented an announced decrease in EHR default dispense quantities from 20 tablets to 12 tablets for commonly prescribed opioids. We measured pre- and post-intervention quantities of opioid tablets prescribed per discharge receiving opioids, distribution by patient demographics, and inter-clinician variability in prescribing behavior.
The EHR change was associated with a 14% decrease in quantity of opioid tablets per discharge receiving opioids, from 14 to 12 tablets (
= <.001). We found no statistically significant disparities in prescriptions based on self-reported patient race (
= 0.68) or gender (
= 0.65). Nurse practitioners and PAs prescribed more opioids per encounter than physicians on average and had a statistically significant decrease in opioid prescriptions associated with the EHR change. Physicians had a lesser but still significant drop in opioid prescribing in the post-intervention period.
Decreasing EHR defaults is a robust, simple tool for decreasing opioid prescriptions, with potential for implementation in the 42% of EDs nationwide that have defaults exceeding the recommended 12-tablet supply. Considering significant inter-clinician variability, future interventions to decrease opioid prescriptions should examine the effects of combining EHR default changes with targeted interventions for clinician groups or individual clinicians.</description><subject>Adult</subject><subject>Analgesics, Opioid - therapeutic use</subject><subject>Behavioral Health</subject><subject>Drug Prescriptions - statistics & numerical data</subject><subject>Electronic Health Records</subject><subject>Emergency Service, Hospital</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Opioid-Related Disorders - prevention & control</subject><subject>Practice Patterns, Physicians' - statistics & numerical data</subject><subject>Quality Improvement</subject><subject>Substance Use Disorder: Original Research</subject><subject>United States</subject><issn>1936-9018</issn><issn>1936-900X</issn><issn>1936-9018</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>DOA</sourceid><recordid>eNpVkU1v1DAQhiMEoqVw5Ip85JLiz8Q-IVQWWFTUAos4Wo49Dl4l8dZOivbf43ZL1Z488jx6POO3ql4TfCokIe_-Qp63MJ4SiTl-Uh0TxZpaYSKfPqiPqhc5bzEWomXieXXEFKaSUnVcdZfJ9KOZg0WrEVIPk92jj7AzaR5hmtF6miFdlyrECf0At9gw9QXwZhlm9H0xpTPvUfToYhdicGhjugHmjC4TZJtCB-5l9cybIcOru_Ok-vVptTn7Up9ffF6ffTivLRUC1xawN6TxGGhnsfCWg-ok560XQlgubaskxVg1DFupjDMNNECF51wyphrJTqr1weui2epdCqNJex1N0LcXMfW6bBXsANq6YmCubQmV3BGqitc7YTqOBcXuxvX-4Not3QjOlg9IZngkfdyZwh_dx2tNCBWcCFoMb-8MKV4tJSQ9hmxhGMwEccmaYUkbKgXHBa0PqE0x5wT-_h2C9U3I-vfq5-br6pu-Dbnwbx4Od0__T5X9A969pHo</recordid><startdate>202407</startdate><enddate>202407</enddate><creator>Gotham Johnson, Drake</creator><creator>Lu, Alice Y</creator><creator>Kirn, Georgia A</creator><creator>Trepka, Kai</creator><creator>Ayana Day, Yesenia</creator><creator>Yang, Stephen C</creator><creator>Montoy, Juan Carlos C</creator><creator>Juarez, Marianne A</creator><general>Department of Emergency Medicine, University of California, Irvine School of Medicine</general><general>eScholarship Publishing, University of California</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>202407</creationdate><title>Pragmatic Emergency Department Intervention Reducing Default Quantity of Opioid Tablets Prescribed</title><author>Gotham Johnson, Drake ; Lu, Alice Y ; Kirn, Georgia A ; Trepka, Kai ; Ayana Day, Yesenia ; Yang, Stephen C ; Montoy, Juan Carlos C ; Juarez, Marianne A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2550-ce0fa16f0e2bc05fc4e9b8447f555c48c7982009630c89ada6e6e25f448339683</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Analgesics, Opioid - therapeutic use</topic><topic>Behavioral Health</topic><topic>Drug Prescriptions - statistics & numerical data</topic><topic>Electronic Health Records</topic><topic>Emergency Service, Hospital</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Opioid-Related Disorders - prevention & control</topic><topic>Practice Patterns, Physicians' - statistics & numerical data</topic><topic>Quality Improvement</topic><topic>Substance Use Disorder: Original Research</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gotham Johnson, Drake</creatorcontrib><creatorcontrib>Lu, Alice Y</creatorcontrib><creatorcontrib>Kirn, Georgia A</creatorcontrib><creatorcontrib>Trepka, Kai</creatorcontrib><creatorcontrib>Ayana Day, Yesenia</creatorcontrib><creatorcontrib>Yang, Stephen C</creatorcontrib><creatorcontrib>Montoy, Juan Carlos C</creatorcontrib><creatorcontrib>Juarez, Marianne A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>The western journal of emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gotham Johnson, Drake</au><au>Lu, Alice Y</au><au>Kirn, Georgia A</au><au>Trepka, Kai</au><au>Ayana Day, Yesenia</au><au>Yang, Stephen C</au><au>Montoy, Juan Carlos C</au><au>Juarez, Marianne A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pragmatic Emergency Department Intervention Reducing Default Quantity of Opioid Tablets Prescribed</atitle><jtitle>The western journal of emergency medicine</jtitle><addtitle>West J Emerg Med</addtitle><date>2024-07</date><risdate>2024</risdate><volume>25</volume><issue>4</issue><spage>449</spage><epage>456</epage><pages>449-456</pages><issn>1936-9018</issn><issn>1936-900X</issn><eissn>1936-9018</eissn><abstract>The opioid epidemic is a major cause of morbidity and mortality in the United States. Prior work has shown that emergency department (ED) opioid prescribing can increase the incidence of opioid use disorder in a dose-dependent manner, and systemic changes that decrease default quantity of discharge opioid tablets in the electronic health record (EHR) can impact prescribing practices. However, ED leadership may be interested in the impact of communication around the intervention as well as whether the intervention may differentially impact different types of clinicians (physicians, physician assistants [PA], and nurse practitioners). We implemented and evaluated a quality improvement intervention of an announced decrease in EHR default quantities of commonly prescribed opioids at a large, academic, urban, tertiary-care ED.
We gathered EHR data on all ED discharges with opioid prescriptions from January 1, 2019-December 6, 2021, including chief complaint, clinician, and opioid prescription details. Data was captured and analyzed on a monthly basis throughout this time period. On March 29, 2021, we implemented an announced decrease in EHR default dispense quantities from 20 tablets to 12 tablets for commonly prescribed opioids. We measured pre- and post-intervention quantities of opioid tablets prescribed per discharge receiving opioids, distribution by patient demographics, and inter-clinician variability in prescribing behavior.
The EHR change was associated with a 14% decrease in quantity of opioid tablets per discharge receiving opioids, from 14 to 12 tablets (
= <.001). We found no statistically significant disparities in prescriptions based on self-reported patient race (
= 0.68) or gender (
= 0.65). Nurse practitioners and PAs prescribed more opioids per encounter than physicians on average and had a statistically significant decrease in opioid prescriptions associated with the EHR change. Physicians had a lesser but still significant drop in opioid prescribing in the post-intervention period.
Decreasing EHR defaults is a robust, simple tool for decreasing opioid prescriptions, with potential for implementation in the 42% of EDs nationwide that have defaults exceeding the recommended 12-tablet supply. Considering significant inter-clinician variability, future interventions to decrease opioid prescriptions should examine the effects of combining EHR default changes with targeted interventions for clinician groups or individual clinicians.</abstract><cop>United States</cop><pub>Department of Emergency Medicine, University of California, Irvine School of Medicine</pub><pmid>39028229</pmid><doi>10.5811/westjem.18040</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1936-9018 |
| ispartof | The western journal of emergency medicine, 2024-07, Vol.25 (4), p.449-456 |
| issn | 1936-9018 1936-900X 1936-9018 |
| language | eng |
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| source | Publicly Available Content Database; PubMed Central |
| subjects | Adult Analgesics, Opioid - therapeutic use Behavioral Health Drug Prescriptions - statistics & numerical data Electronic Health Records Emergency Service, Hospital Female Humans Male Middle Aged Opioid-Related Disorders - prevention & control Practice Patterns, Physicians' - statistics & numerical data Quality Improvement Substance Use Disorder: Original Research United States |
| title | Pragmatic Emergency Department Intervention Reducing Default Quantity of Opioid Tablets Prescribed |
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