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{ "pk": 18040, "title": "Pragmatic Emergency Department Intervention Reducing Default Quantity of Opioid Tablets Prescribed", "subtitle": null, "abstract": "<p><strong>Introduction: </strong>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.</p>\n<p><strong>Methods:</strong> 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.</p>\n<p><strong>Results:</strong> The EHR change was associated with a 14% decrease in quantity of opioid tablets per discharge receiving opioids, from 14 to 12 tablets (P =<.001). We found no statistically significant disparities in prescriptions based on self-reported patient race (P = 0.68) or gender (P = 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.</p>\n<p><strong>Conclusion:</strong> 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.</p>", "language": null, "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "EMR" }, { "word": "Opioids" }, { "word": "Quality Improvement" }, { "word": "Emergency Medicine" }, { "word": "Addiction Medicine" } ], "section": "Behavioral Health", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/0wq321gt", "frozenauthors": [ { "first_name": "Drake", "middle_name": "Gotham", "last_name": "Johnson", "name_suffix": "", "institution": "University of California San Francisco, Department of Emergency Medicine, San Francisco, California", "department": "None" }, { "first_name": "Alice", "middle_name": "Y.", "last_name": "Lu", "name_suffix": "", "institution": "University of California San Francisco, Department of Emergency Medicine, San Francisco, California", "department": "None" }, { "first_name": "Georgia", "middle_name": "A.", "last_name": "Kirn", "name_suffix": "", "institution": "University of California San Francisco, Department of Emergency Medicine, San Francisco, California", "department": "None" }, { "first_name": "Kai", "middle_name": "", "last_name": "Trepka", "name_suffix": "", "institution": "University of California San Francisco, Department of Emergency Medicine, San Francisco, California", "department": "None" }, { "first_name": "Yesenia", "middle_name": "Ayana", "last_name": "Day", "name_suffix": "", "institution": "University of California San Francisco, Department of Emergency Medicine, San Francisco, California", "department": "None" }, { "first_name": "Stephen", "middle_name": "C.", "last_name": "Yang", "name_suffix": "", "institution": "University of California San Francisco, Department of Emergency Medicine, San Francisco, California", "department": "None" }, { "first_name": "Juan Carlos", "middle_name": "C.", "last_name": "Montoy", "name_suffix": "", "institution": "University of California San Francisco, Department of Emergency Medicine, San Francisco, California", "department": "None" }, { "first_name": "Marianne", "middle_name": "A.", "last_name": "Juarez", "name_suffix": "", "institution": "University of California San Francisco, Department of Emergency Medicine, San Francisco, California", "department": "None" } ], "date_submitted": "2023-04-02T01:44:11+02:00", "date_accepted": "2023-04-02T01:44:11+02:00", "date_published": "2024-05-20T15:00:00+02:00", "render_galley": { "label": "Final Article", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/18040/galley/10858/download/" }, "galleys": [ { "label": "Layout", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/18040/galley/10128/download/" }, { "label": "Final Article", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/18040/galley/10858/download/" } ] }