Swedish Medical Center, 501 E Hampden Ave, Englewood, CO 80113, United States.
Rueckert-Hartman College for Health Professions, Regis University, 3333 Regis Blvd., Denver, CO 80221, United States.
Am J Emerg Med. 2019 Jan;37(1):38-44. doi: 10.1016/j.ajem.2018.04.043. Epub 2018 Apr 22.
The objective of this study was to assess opioid use in an emergency department following the development and implementation of an alternative to opioids (ALTO)-first approach to pain management. The study also assessed how implementation affected patient satisfaction scores.
This study compared data collected from October to December of 2015 (prior to implementation) to data collected between October and December of 2016 (after the intervention had been implemented). Emergency department visits during the study timeframe were included. Opioid reduction was measured in morphine equivalents (ME) administered per visit. Secondary outcomes on patient satisfaction were gathered using the Press Ganey survey.
Intravenous (IV) opioid administration during the study period decreased by >20%. The predicted mean ME use in 2016 was 0.25 ME less when compared to 2015 (95% CI -0.27 to -0.23). Estimated use for patients in the pre-implementation period was 1.45 ME mgs (SD 0.88), and 1.13 ME mg (SD 0.69) for patients in the post-implementation period. Patient satisfaction scores using the Press Ganey Scale also were assessed. There was no significant difference in the scores between 2015 and 2016 when patients were asked "How well was you pain controlled?" (-0.94, 95% CI -5.29 to 3.4) and "How likely are you to recommend this emergency department?" (-1.55, 95% CI -5.26 to 2.14).
In conclusion, by using an ALTO-first, multimodal treatment approach to pain management, participating clinicians were able to significantly decrease the use of IV opioids in the emergency department. Patient satisfaction scores remained unchanged following implementation.
本研究旨在评估在实施替代阿片类药物（ALTO）的疼痛管理方法后，急诊部门阿片类药物的使用情况。该研究还评估了实施情况如何影响患者满意度评分。
本研究比较了 2015 年 10 月至 12 月（实施前）和 2016 年 10 月至 12 月（干预实施后）收集的数据。研究期间的急诊就诊均包括在内。通过每次就诊给予的吗啡当量（ME）来衡量阿片类药物的减少量。使用 Press Ganey 调查收集患者满意度的次要结果。
在研究期间，静脉（IV）阿片类药物的给药量减少了 >20%。与 2015 年相比，2016 年的预测平均 ME 使用量减少了 0.25 ME（95%CI -0.27 至 -0.23）。实施前患者的预计使用量为 1.45 ME mgs（SD 0.88），实施后患者的使用量为 1.13 ME mg（SD 0.69）。还评估了使用 Press Ganey 量表的患者满意度评分。当询问患者“您的疼痛控制得如何？”（-0.94，95%CI -5.29 至 3.4）和“您推荐这家急诊室的可能性有多大？”（-1.55，95%CI -5.26 至 2.14）时，2015 年和 2016 年之间的评分没有显著差异。
总之，通过使用 ALTO 优先、多模式治疗方法来管理疼痛，参与的临床医生能够显著减少急诊部门 IV 阿片类药物的使用。实施后患者满意度评分保持不变。
