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Analgesic Administration for Patients with Renal Colic in the Emergency Department Before and After Implementation of an Opioid Reduction Initiative.
West J Emerg Med. 2018 Nov; 19(6):1028-1035.WJ

Abstract

Introduction

We aimed to evaluate the patterns of analgesic prescribing for emergency department (ED) patients suffering from pain of renal colic before, during, and after implementation of an opioid reduction initiative. We hypothesized that this initiative based on the concept of channels/enzymes/receptors-targeted analgesia would result in overall decrease in opioid utilization in the ED and at discharge.

Methods

We performed a retrospective analysis of ED electronic medical record of patients presenting with renal colic who received analgesics in the ED and at discharge over a five-year period. Patients were divided into three groups based on the following periods: 2012-2014 (pre-implementation phase); 2014-2015 (implementation phase); and 2015-2017 (post-implementation).

Results

A total of 4,490 patients presented to the ED with renal colic over a five-year study period. Analgesics were administered to 3,793 ED patients of whom 1,704 received opioids and 2,675 received non-opioid analgesics. A total of 3,533 ED patients received a prescription for analgesic(s) upon discharge from the ED: 2,692 patients received opioids, and 2,228 received non-opioids. We observed a 12.7% overall decrease from the pre-implementation to post-implementation time period in opioid prescribing in the ED and a 25.5% decrease in opioid prescribing at discharge, which translated into 432 and 768 fewer patients receiving opioids, respectively.

Conclusion

Implementation of an opioid-reduction initiative based on patient-specific, pain syndrome-targeted opioid alternative protocols resulted in a reduction in opioid administration in the ED by 12.7% and at prescriptions at discharge by 25.5%. Adoption of similar ED initiatives nationwide has the potential to foster effective non-opioid analgesic practices for ED patients presenting with renal colic and to reduce physicians' reliance on administering and prescribing opioids.

Authors+Show Affiliations

Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York.Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York.Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York.Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York.Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York.Peter Flom Consulting, New York, New York.Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30429938

Citation

Motov, Sergey, et al. "Analgesic Administration for Patients With Renal Colic in the Emergency Department Before and After Implementation of an Opioid Reduction Initiative." The Western Journal of Emergency Medicine, vol. 19, no. 6, 2018, pp. 1028-1035.
Motov S, Drapkin J, Butt M, et al. Analgesic Administration for Patients with Renal Colic in the Emergency Department Before and After Implementation of an Opioid Reduction Initiative. West J Emerg Med. 2018;19(6):1028-1035.
Motov, S., Drapkin, J., Butt, M., Thorson, A., Likourezos, A., Flom, P., & Marshall, J. (2018). Analgesic Administration for Patients with Renal Colic in the Emergency Department Before and After Implementation of an Opioid Reduction Initiative. The Western Journal of Emergency Medicine, 19(6), 1028-1035. https://doi.org/10.5811/westjem.2018.9.38875
Motov S, et al. Analgesic Administration for Patients With Renal Colic in the Emergency Department Before and After Implementation of an Opioid Reduction Initiative. West J Emerg Med. 2018;19(6):1028-1035. PubMed PMID: 30429938.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Analgesic Administration for Patients with Renal Colic in the Emergency Department Before and After Implementation of an Opioid Reduction Initiative. AU - Motov,Sergey, AU - Drapkin,Jefferson, AU - Butt,Mahlaqa, AU - Thorson,Andrew, AU - Likourezos,Antonios, AU - Flom,Peter, AU - Marshall,John, Y1 - 2018/10/18/ PY - 2018/05/02/received PY - 2018/09/21/revised PY - 2018/09/21/accepted PY - 2018/11/16/entrez PY - 2018/11/16/pubmed PY - 2018/12/27/medline SP - 1028 EP - 1035 JF - The western journal of emergency medicine JO - West J Emerg Med VL - 19 IS - 6 N2 - Introduction: We aimed to evaluate the patterns of analgesic prescribing for emergency department (ED) patients suffering from pain of renal colic before, during, and after implementation of an opioid reduction initiative. We hypothesized that this initiative based on the concept of channels/enzymes/receptors-targeted analgesia would result in overall decrease in opioid utilization in the ED and at discharge. Methods: We performed a retrospective analysis of ED electronic medical record of patients presenting with renal colic who received analgesics in the ED and at discharge over a five-year period. Patients were divided into three groups based on the following periods: 2012-2014 (pre-implementation phase); 2014-2015 (implementation phase); and 2015-2017 (post-implementation). Results: A total of 4,490 patients presented to the ED with renal colic over a five-year study period. Analgesics were administered to 3,793 ED patients of whom 1,704 received opioids and 2,675 received non-opioid analgesics. A total of 3,533 ED patients received a prescription for analgesic(s) upon discharge from the ED: 2,692 patients received opioids, and 2,228 received non-opioids. We observed a 12.7% overall decrease from the pre-implementation to post-implementation time period in opioid prescribing in the ED and a 25.5% decrease in opioid prescribing at discharge, which translated into 432 and 768 fewer patients receiving opioids, respectively. Conclusion: Implementation of an opioid-reduction initiative based on patient-specific, pain syndrome-targeted opioid alternative protocols resulted in a reduction in opioid administration in the ED by 12.7% and at prescriptions at discharge by 25.5%. Adoption of similar ED initiatives nationwide has the potential to foster effective non-opioid analgesic practices for ED patients presenting with renal colic and to reduce physicians' reliance on administering and prescribing opioids. SN - 1936-9018 UR - https://www.unboundmedicine.com/medline/citation/30429938/Analgesic_Administration_for_Patients_with_Renal_Colic_in_the_Emergency_Department_Before_and_After_Implementation_of_an_Opioid_Reduction_Initiative_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/30429938/ DB - PRIME DP - Unbound Medicine ER -