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Feasibility Study of a Quasi-experimental Regional Opioid Safety Prescribing Program in Veterans Health Administration Emergency Departments.

Publication ,  Journal Article
Dieujuste, N; Johnson-Koenke, R; Christopher, M; Gunzburger, EC; Emmendorfer, T; Kessler, C; Haukoos, J; Smith, J; Sasson, C
Published in: Acad Emerg Med
August 2020

BACKGROUND: The Veterans Health Administration (VHA) Opioid Safety Initiative (OSI) was implemented in 2013 and was associated with a 25% relative decrease in the dispensing of opioids. Although emergency department (ED) providers play a role in the initiation and continuation of opioids, the incumbent OSI did not target EDs. OBJECTIVE: The goal of this feasibility study was to leverage the existing VHA OSI and test a novel ED-based quality improvement (QI) program to decrease opioid prescribing in multiple ED settings. METHODS: This was a quasi-experimental study of phased-in implementation of a QI ED-based OSI. The general setting for this pilot were four VHA EDs across the Veterans Integrated Services Network (VISN) region 19: Denver, Oklahoma City, Muskogee, and Salt Lake City. We developed and disseminated a dashboard to assess ED-specific prescribing rates and an ED-tailored toolkit to implement the program. Academic detailing pharmacists provided focused audits and feedback with the highest prescribing providers. We measured change in ED-provider prescribing rate of opioids for patients discharged from the ED, by provider and aggregated up to facility level, pre- and postimplementation. RESULTS: Interrupted time-series analysis of provider-level data from the program implementation sites indicated a significant decrease in the trend for proportion of opioid prescriptions relative to the preintervention trend. The results of the analysis suggest that the intervention was associated with accelerating the rate at which ED provider prescribing rates decreased. CONCLUSION: Due to the high volume of patients and the vital role the ED plays in patient treatment and hospital admissions, it is evident that the ED is an important site for QI programs as well as the implementation of opioid safety measures. Given the findings of this pilot, we believe that implementation of a national Veterans Affairs ED OSI implementation is feasible practice.

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Published In

Acad Emerg Med

DOI

EISSN

1553-2712

Publication Date

August 2020

Volume

27

Issue

8

Start / End Page

734 / 741

Location

United States

Related Subject Headings

  • Veterans Health
  • Practice Patterns, Physicians'
  • Oklahoma
  • Humans
  • Feasibility Studies
  • Emergency Service, Hospital
  • Emergency & Critical Care Medicine
  • Analgesics, Opioid
  • 3202 Clinical sciences
  • 1117 Public Health and Health Services
 

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Dieujuste, N., Johnson-Koenke, R., Christopher, M., Gunzburger, E. C., Emmendorfer, T., Kessler, C., … Sasson, C. (2020). Feasibility Study of a Quasi-experimental Regional Opioid Safety Prescribing Program in Veterans Health Administration Emergency Departments. Acad Emerg Med, 27(8), 734–741. https://doi.org/10.1111/acem.13980
Dieujuste, Nathalie, Rachel Johnson-Koenke, Melissa Christopher, Elise C. Gunzburger, Thomas Emmendorfer, Chad Kessler, Jason Haukoos, Jason Smith, and Comilla Sasson. “Feasibility Study of a Quasi-experimental Regional Opioid Safety Prescribing Program in Veterans Health Administration Emergency Departments.Acad Emerg Med 27, no. 8 (August 2020): 734–41. https://doi.org/10.1111/acem.13980.
Dieujuste N, Johnson-Koenke R, Christopher M, Gunzburger EC, Emmendorfer T, Kessler C, et al. Feasibility Study of a Quasi-experimental Regional Opioid Safety Prescribing Program in Veterans Health Administration Emergency Departments. Acad Emerg Med. 2020 Aug;27(8):734–41.
Dieujuste, Nathalie, et al. “Feasibility Study of a Quasi-experimental Regional Opioid Safety Prescribing Program in Veterans Health Administration Emergency Departments.Acad Emerg Med, vol. 27, no. 8, Aug. 2020, pp. 734–41. Pubmed, doi:10.1111/acem.13980.
Dieujuste N, Johnson-Koenke R, Christopher M, Gunzburger EC, Emmendorfer T, Kessler C, Haukoos J, Smith J, Sasson C. Feasibility Study of a Quasi-experimental Regional Opioid Safety Prescribing Program in Veterans Health Administration Emergency Departments. Acad Emerg Med. 2020 Aug;27(8):734–741.
Journal cover image

Published In

Acad Emerg Med

DOI

EISSN

1553-2712

Publication Date

August 2020

Volume

27

Issue

8

Start / End Page

734 / 741

Location

United States

Related Subject Headings

  • Veterans Health
  • Practice Patterns, Physicians'
  • Oklahoma
  • Humans
  • Feasibility Studies
  • Emergency Service, Hospital
  • Emergency & Critical Care Medicine
  • Analgesics, Opioid
  • 3202 Clinical sciences
  • 1117 Public Health and Health Services