16 The Impact of an Emergency Department Alternatives to Opiates (ALTO) Program on Opiate Administration
Recommended Citation
Marshall D, Krupp SS, Khoury R, MacDonald N, Tokarski G, Makowski C, Miller JB, Manteuffel J. 16 The Impact of an Emergency Department Alternatives to Opiates (ALTO) Program on Opiate Administration. Ann Emerg Med 2022; 80(4):S7.
Document Type
Conference Proceeding
Publication Date
10-1-2022
Publication Title
Ann Emerg Med
Abstract
Study Objectives: The primary aim was to measure the impact of an Alternatives to Opiates (ALTO) program on decreasing opioid administration in the emergency department (ED). Methods: We launched an ALTO program in November 2019 across 9 EDs within an integrated health system that together sees approximately 450,000 patient encounters annually. A multi-disciplinary group inclusive of ED providers, pharmacists, and nursing developed the ALTO program using existing best practices and publications. The program included a “Quicklist”: an organized section of non-opiate pain medications for indicated conditions, readily accessible within the electronic medical record (EMR). Prior to implementation, we provided education to clinicians and nursing and continued re-education in 4-month intervals after program implementation. For this analysis, we included all patients if they were discharged from the ED. Our primary outcome consisted of opioid administration, measured in morphine milliequivalents (MME) per discharged patient encounter. We compared the average MME in the 3 years prior to vs. the 21-month period following program implementation (December 2019 – August 2021). We secondarily measured the change in administration of intravenous sub-dissociative ketamine, oral methocarbamol, and lidocaine patches during the same periods, adjusted for ED volume. Results: Opiate administration decreased across the entire Henry Ford Health System (HFHS) from 1.46 ±0.58 MME per patient encounter to 1.31 ±0.53 MME per patient encounter, an 11.7% (95% CI 2.7 - 18.8%, p=0.015) decrease. Across the 9 HFHS EDs the percentage change was variable ranging from a 1% increase in one particular ED to a 29.0% decrease in another ED. Sub-analysis showed opiate administration at the largest ED decreased from 2.59 MME per patient encounter to 2.17 MME per patient encounter, a 16.1% (95% CI 6.1 - 26.1 %, p<0.001) decrease. Across all EDs, intravenous sub-dissociative ketamine administrations increased 186.2% (p<0.001), oral methocarbamol administrations increased 28.6% (p<0.001), and lidocaine patch administrations increased 132.6% (p<0.001) in the 21.5-month period after ALTO implementation as compared to the 21.5-month period before ALTO implementation after adjustment for ED volume. Conclusions: The HFHS ALTO program significantly decreased opiate administration across the system. The increase in the use of ALTO medications suggests adoption of the ALTO program amongst providers. Continued ALTO program education is needed as is further study with more nuanced data analysis accounting for ED length of stay and provider level data. No, authors do not have interests to disclose
Volume
80
Issue
4
First Page
S7
