University of South Dakota Sanford School of Medicine.
S D Med. 2023 Sep;76(9):395.
Prior studies have demonstrated that the use of opioids in an Emergency Department (ED) increases the chances of a 30-day return to the ED for similar diagnoses. Super-utilizers (SUs) of the EDs tax the ED resources, resulting in sub-optimal outcomes for these patients. Most physicians receive sub-optimal formal training on pain and opioid prescribing. These facts provide an area of improvement for administering optimal patient care in the ED. Presenting a structured curriculum on how to treat patients with pain in the ED could result in a simple, cost-effective solution to decrease provider work-overload, decrease misuse of healthcare resources, and increase the well-being of opioid-addicted patients.
The American Academy of Emergency Medicine's Model ED Pain Treatment Guidelines were presented to ED physicians at virtual and in-person department meetings at five EDs in the Midwestern United States. Retrospective (Phase I) and prospective data (Phase II) of all ED visits for each hospital were collected and de-identified. The raw data were segregated by ICD-10 codes to identify the visits made for pain diagnoses. SU was defined as any patient who visited the ED more than once for the same pain diagnosis. McNemar's test assessed the change in the number of SUs. Z-Scores assessed the change in number of visits by SUs and visits made by non-SUs between the two phases. Data were categorized by hospital and by total type of SUs based on how many visits they made.
The data from Phase I were assessed and divided by hospital into three groups, those that used the ED more than once, more than twice, and more than three times for the same diagnosis. A statistically significant decrease (p-value = 0.0006) was noted in the group that visited the ED more than once from Phase I (n=4,413) to Phase II (n=4,109). There was a statistically significant decrease (p-value = 0.0008) in number of visits (n=268) by SUs. There was a decrease in visits made by non-SUs (n=292) but it was not statistically significant (p-value=0.9992).
Opioid prescribing education was associated with decreased SUs who visited the ED more than once and in total visits made by SUs. This decrease in visits could be correlated to an estimated savings of over $1 million across five EDs with an estimated total 70,000 annual patient volume ED based on average costs of ED visits by SUs. There was no significant change in the groups of SUs who visited more than twice or more than three times. Provider opioid prescribing education may have little or no effect on some patients who may chronically use the ED for pain-related diagnoses, regardless of the training of the emergency providers.
先前的研究表明，在急诊科（ED）使用阿片类药物会增加 30 天内因类似诊断而返回 ED 的几率。ED 的超级使用者（SU）会消耗 ED 资源，导致这些患者的治疗效果不理想。大多数医生在接受疼痛和阿片类药物处方方面的正规培训都不够理想。这些事实为在 ED 中提供最佳患者护理提供了一个改进的领域。提出一个关于如何在 ED 中治疗疼痛患者的结构化课程，可能会为减少提供者工作负荷、减少医疗资源滥用和增加阿片类药物成瘾患者的幸福感提供一个简单、具有成本效益的解决方案。
在美国中西部的五家 ED 医院的虚拟和现场部门会议上向 ED 医生介绍了美国急诊医师学院的 ED 疼痛治疗指南模型。每家医院的所有 ED 就诊的回顾性（第 I 阶段）和前瞻性数据（第 II 阶段）都被收集并进行去识别。原始数据按 ICD-10 代码进行分类，以确定疼痛诊断的就诊情况。SU 被定义为因同一疼痛诊断而到 ED 就诊超过一次的任何患者。McNemar 检验评估了 SU 数量的变化。Z 分数评估了 SU 和非 SU 在两个阶段之间的就诊次数和就诊次数的变化。数据根据医院和基于就诊次数的 SU 总类型进行分类。
对第 I 阶段的数据进行评估，并根据医院分为三组，即因同一诊断到 ED 就诊一次以上、两次以上和三次以上的患者。从第 I 阶段（n=4413）到第 II 阶段（n=4109），到 ED 就诊一次以上的患者数量显著减少（p 值=0.0006）。SU 的就诊次数（n=268）显著减少（p 值=0.0008）。非 SU 的就诊次数（n=292）有所减少，但无统计学意义（p 值=0.9992）。
阿片类药物处方教育与到 ED 就诊一次以上的 SU 数量减少和 SU 就诊总数减少有关。这种就诊次数的减少可能与五家 ED 基于 SU 每次就诊的平均费用估计的超过 7 万例每年患者就诊量相关的超过 100 万美元的估计节省有关。到 ED 就诊两次以上或三次以上的 SU 组没有明显变化。无论急诊提供者的培训如何，提供者的阿片类药物处方教育可能对一些可能长期因疼痛相关诊断而使用 ED 的患者几乎没有或没有影响。
