R M Higgins1, C C Petro2, J Warren3, A J Perez4, T Dews5, S Phillips6, M Reinhorn7. 1. Division of Minimally Invasive Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA. rhiggins@mcw.edu. 2. Center for Abdominal Core Health, Cleveland Clinic, Cleveland, OH, USA. 3. The University of South Carolina School of Medicine Greenville, Greenville, SC, USA. 4. Division of General, Acute Care and Trauma Surgery, The University of North Carolina, Chapel Hill, NC, USA. 5. Pain Management Department, Cleveland Clinic Euclid Hospital, Cleveland, OH, USA. 6. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA. 7. Mass General Brigham-Newton Wellesley Hospital, Boston Hernia and Pilonidal Center, Newton, MA, USA.
Abstract
PURPOSE: Post-operative opioid prescriptions contribute to prolonged opioid misuse and abuse. Using a national hernia registry, we aimed to evaluate the effectiveness of a data-driven educational intervention on surgeon prescribing behavior. METHODS: After collecting opioid prescribing and patient consumption data from March 2019-December 2019 in inguinal and umbilical hernia repair, the Abdominal Core Health Quality Collaborative (ACHQC) Opioid Reduction Task Force presented data at a Quality Improvement (QI) Summit to educate surgeons on strategies to minimize opioid prescribing. Surgeons were asked to implement a multimodal pain management approach and were supported with educational tools created by the task force. Prescribing and consumption data after the summit, December 2019-March 2021, were then collected to assess the effectiveness of the QI effort. RESULTS: Registry participation before and after the QI summit increased from 52 to 91 surgeons, with an increase of 353-830 umbilical hernia patients and 976-2447 inguinal hernia patients. After the summit, high (> 10 tablets) surgeon prescribers shifted toward low (≤ 10 tablets) prescribing. Yet, patients consumed less than what was prescribed, with a significant increase in patients consuming ≤ 10 tablets before and after the summit: 79-88% in umbilical hernia (p = 0.01) and 85-94% in inguinal hernia (p < 0.001). CONCLUSIONS: Following an educational QI summit by the ACHQC Opioid Reduction Task Force, high opioid prescribing has shifted toward low. However, patients consume less than prescribed, highlighting the importance of continuing this effort to reduce opioid prescribing.
PURPOSE: Post-operative opioid prescriptions contribute to prolonged opioid misuse and abuse. Using a national hernia registry, we aimed to evaluate the effectiveness of a data-driven educational intervention on surgeon prescribing behavior. METHODS: After collecting opioid prescribing and patient consumption data from March 2019-December 2019 in inguinal and umbilical hernia repair, the Abdominal Core Health Quality Collaborative (ACHQC) Opioid Reduction Task Force presented data at a Quality Improvement (QI) Summit to educate surgeons on strategies to minimize opioid prescribing. Surgeons were asked to implement a multimodal pain management approach and were supported with educational tools created by the task force. Prescribing and consumption data after the summit, December 2019-March 2021, were then collected to assess the effectiveness of the QI effort. RESULTS: Registry participation before and after the QI summit increased from 52 to 91 surgeons, with an increase of 353-830 umbilical hernia patients and 976-2447 inguinal hernia patients. After the summit, high (> 10 tablets) surgeon prescribers shifted toward low (≤ 10 tablets) prescribing. Yet, patients consumed less than what was prescribed, with a significant increase in patients consuming ≤ 10 tablets before and after the summit: 79-88% in umbilical hernia (p = 0.01) and 85-94% in inguinal hernia (p < 0.001). CONCLUSIONS: Following an educational QI summit by the ACHQC Opioid Reduction Task Force, high opioid prescribing has shifted toward low. However, patients consume less than prescribed, highlighting the importance of continuing this effort to reduce opioid prescribing.
Authors: Heidi N Overton; Marie N Hanna; William E Bruhn; Susan Hutfless; Mark C Bicket; Martin A Makary Journal: J Am Coll Surg Date: 2018-08-14 Impact factor: 6.113