Brief Provider Education is Associated with Decreased ED Visits by Super-utilizers.

BACKGROUND: Millions of adult visits to emergency departments (EDs) each year are opioid-related, and those who visit with chronic pain are more likely to be super-utilizers (SUs) of the ED. Although SUs comprise 5% of the general population, they account for 50% of health care expenditure. OBJECTIVE: Determine whether brief provider opioid education results in decreased number of SUs and total ED visits by SUs. METHODS: The American Academy of Emergency Medicine's ED Opioid Prescribing Guidelines were presented to five EDs (estimated total 70,000 ED annual patient volume). ICD-10 codes from visits one year before and after the education were evaluated for painful diagnoses and identified patients who fit the definition of SU. Statistical analysis was performed on the data using McNemar's test and Z-scores. RESULTS: A statistically significant decrease (p=0.0006) in patients who visited the ED more than once after the education compared to prior to the education (n=304) was found. A statistically significant decrease (p=0.0017) in total number of visits after the education (n=268) by SU patients was found. No statistically significant change in visits made by non-SU patients (p=1.9983), nor average number of visits made by SUs (p=0.2320) was found. CONCLUSION: Providing opioid education to ED providers was associated with a significant reduction in number of SUs visiting the ED and number of visits made by SUs. Based on average costs of ED visits by SUs, this decrease in visits can be correlated to an estimated savings of over $1 million across five EDs.

Brief Provider Opioid Education Is Associated with Decreased Super-Utilization in a Rural Emergency Department.

BACKGROUND: Patients who suffer chronic pain may seek the emergency department for opioids. There is no consensus on what constitutes an ED super-utilizer, so our definition is anyone who presented to the ED more than once for the same painful complaint. We sought to assess the effect of opioid guideline education for providers on super-utilizer visits for pain. METHODS: We performed a retrospective review of visits for chief complaints of pain one year before (phase one) and one year after (phase two) educating ED providers. The educational intervention consisted of a 20-minute explanation of the American Academy of Emergency Medicine's Model ED Pain Treatment Guidelines. McNemar's test was applied to the resultant data. RESULTS: Phase one identified 218 super-utilizers accounting for 660 ED visits. Phase two identified 190 super- utilizers accounting for 604 ED visits. Both groups were stratified into those using the ED more than once, more than twice, and more than three times. There was a statistically significant difference in patients visiting the ED more than once (p=0.01) and more than three times (p=0.027), but not for those visiting more than twice (p=0.18). There was no statistically significant difference in total patient ED visits in any subgroup. CONCLUSION: The total number of super-utilizers significantly decreased after the educational intervention. This educational intervention required minimal monetary and time investment. Further research is needed to determine if the educational intervention resulted in decreased opioid prescriptions and decreased number of people utilizing these drugs for non-medical purposes.

No Pain, No Thebaine: Opioids in the Emergency Department.

BACKGROUND: Opioid misuse has reached epidemic levels. Forty-six people die every day in the U.S. from prescription opioids. Opioid-taking patients cost emergency departments (EDs) and society more than non-opioid-taking patients. Many patients prescribed opioids will go on to become addicted, yet we find it much easier to prescribe these medications than explain to the patient why they are not indicated. The ED takes care of many of these people, whether by prescribing opioids, or treating opioid misuse. We examine the ED's role in this epidemic. METHODS: Data were obtained through literature search and the authors' personal experiences treating patients in the ED. The search was limited to specific harm to patients, hospitals, and society caused by opioid misuse, physiology of pain, and possible methods to manage the problem. CONCLUSIONS: The ED clearly deserves some of the blame for the opioid epidemic. A consistent reinforcement of appropriate expectations for management of chronic pain across the medical spectrum will do much to manage the problem. We offer some ways to improve the problem, including pain contracts, pain guidelines, alternative therapies, pain management referrals, high-risk patient profiles, legislation, and drug take-back programs.