No abstract

Background: The opioid overdose epidemic remains one of the leading focuses of the United States’ public health agenda. Current literature has suggested that many surgical procedures are associated with an increased risk of chronic opioid use in the post-operative period of opioid-naïve patients. We aimed to assess whether providing feedback on the average morphine milligram equivalents (MMED) and opioid utilization by selected post-operative patients would impact the provider opioid prescribing patterns. Methods: An opioid stewardship educational intervention provided didactic and email feedback to general surgeons about their prescribing patterns and summary feedback on opioid usage among post-operative patients from the pre-intervention period. We used descriptive statistics, Chi Square, Fisher’s Exact test, Wilcoxon Rank Sum, two sample t test, and Spearman’s rho to analyze the data gathered. Results: A total of 5142 patients with an average age of 43.9 years were included in the study period. Women accounted for 3096 (60.2%) and 2046 (39.8%) were men. The surgeries during the study period included 1928 (37.5%) appendectomies and 3214 (62.5%) cholecystectomies. The predominant surgical approach was laparoscopic 5028 (97.8%). In both groups, the total MMED and total number of pills prescribed decreased significantly after the intervention was implemented. There were no refill prescriptions nor 30-day readmissions among those discharged with an opioid prescription in either study phase. Discussion: An intervention that provided general surgeons with feedback about their post-operative prescription patterns and data on post-operative opioid utilization by patients decreased prescribed MMED.

received an EIT consultation were compared to those who received standard care without an EIT consultation. Patients were excluded if they were < 18 years of age and had a documented limitation of care (DNAR or advanced directive) prior to arrival to the ED. The study cohort was identified by an electronic data query of the electronic medical record. The primary outcome of interest was hospital length of stay (LOS). Secondary outcomes of interest included mortality, ICU LOS, ventilator free days and change in modified SOFA score. Results: Eight hundred and seventy patients met inclusion criteria. Of these, 546 had all the variables available to calculate a modified SOFA score resulting in 148 (Tests) who received an EIT consult and 398 (Controls) who did not. Following propensity matching using age, BMI and race, there was no difference in the primary outcome of interest: hospital LOS. Patients who received an EIT consultation had a longer median (IQR) ED boarding time, 8(4-14) hours vs. 4(2-6) hours, p < 0.001. Secondary analysis noted that there was a greater probability that the number of EIT cases increased as the quartile of baseline modified SOFA score increased, p < 0.001. At 24 hours, the modified SOFA scores were significantly higher than baseline for both test and control cases. However, at 48 hours the modified SOFA scores were still significantly higher than baseline for control cases, but not for test cases. Conclusion: This retrospective observational study identified that an ED-centric critical care consultation service with specialty trained physicians for ICU boarders, is utilized in patients with longer boarding times and higher severity of illness. This is associated with an improvement in the baseline modified SOFA score at 48 hours of hospitalization.