Hawk Kathryn F, Weiner Scott G, Rothenberg Craig, Bernstein Edward, D'Onofrio Gail, Herring Andrew, Hoppe Jason, Ketcham Eric, LaPietra Alexis, Nelson Lewis, Perrone Jeanmarie, Ranney Megan, Samuels Elizabeth A, Strayer Reuben, Sharma Dhruv, Goyal Pawan, Schuur Jeremiah, Venkatesh Arjun K
Department of Emergency Medicine, Yale School of Medicine, New Haven, CT.
Brigham and Women's Hospital, Boston, MA.
Ann Emerg Med. 2024 Mar;83(3):225-234. doi: 10.1016/j.annemergmed.2023.08.490. Epub 2023 Oct 11.
The American College of Emergency Physicians (ACEP) Emergency Medicine Quality Network (E-QUAL) Opioid Initiative was launched in 2018 to advance the dissemination of evidence-based resources to promote the care of emergency department (ED) patients with opioid use disorder. This virtual platform-based national learning collaborative includes a low-burden, structured quality improvement project, data benchmarking, tailored educational content, and resources designed to support a nationwide network of EDs with limited administrative and research infrastructure. As a part of this collaboration, we convened a group of experts to identify and design a set of measures to improve opioid prescribing practices to provide safe analgesia while reducing opioid-related harms. We present those measures here, alongside initial performance data on those measures from a sample of 370 nationwide community EDs participating in the 2019 E-QUAL collaborative. Measures include proportion of opioid administration in the ED, proportion of alternatives to opioids as first-line treatment, proportion of opioid prescription, opioid pill count per prescription, and patient medication safety education among ED visits for atraumatic back pain, dental pain, or headache. The proportion of benzodiazepine and opioid coprescribing for ED visits for atraumatic back pain was also evaluated. This project developed and effectively implemented a collection of 6 potential measures to evaluate opioid analgesic prescribing across a national sample of community EDs, representing the first feasibility assessment of opioid prescribing-related measures from rural and community EDs.
美国急诊医师学会（ACEP）急诊医学质量网络（E-QUAL）阿片类药物倡议于2018年启动，旨在推动循证资源的传播，以促进对患有阿片类药物使用障碍的急诊科（ED）患者的护理。这个基于虚拟平台的全国性学习协作项目包括一个低负担、结构化的质量改进项目、数据基准测试、量身定制的教育内容，以及旨在支持全国范围内行政和研究基础设施有限的急诊科网络的资源。作为该协作项目的一部分，我们召集了一组专家，以确定和设计一套措施，改善阿片类药物处方实践，在提供安全镇痛的同时减少与阿片类药物相关的危害。我们在此展示这些措施，以及来自参与2019年E-QUAL协作项目的370家全国社区急诊科样本的这些措施的初步绩效数据。措施包括急诊科阿片类药物给药比例、阿片类药物替代方案作为一线治疗的比例、阿片类药物处方比例、每张处方的阿片类药丸数量，以及在因非创伤性背痛、牙痛或头痛就诊的急诊科患者中的患者用药安全教育。还评估了因非创伤性背痛就诊的急诊科患者中苯二氮䓬类药物与阿片类药物联合处方的比例。该项目制定并有效实施了一套6项潜在措施，以评估全国社区急诊科样本中的阿片类镇痛药物处方情况，这是对农村和社区急诊科与阿片类药物处方相关措施的首次可行性评估。
