(1212) Opioid-Related ED Morbidity, Mortality, and the Impact of a Multifaceted Pain Stewardship Initiative

Introduction: Opioid-related morbidity and mortality continue to rise locally and nationally. We developed a comprehensive pain strategic plan in 2019, which implemented strategies across the health system to provide better pain-related care, decrease prescribing variations, and develop infrastructure to ensure sustainability. Since implementation, the rate of opioid prescriptions fell by 25%, morphine milligram equivalents prescribed fell by 11%, naloxone co-prescribing increased by 2012%, and prescribing of medications for opioid use disorder (MOUD) increased by 320%. It is unclear if these surrogate metrics are associated with clinical outcomes. The goal of this project was to measure specifically one aspect of clinical outcomes: opioid-related emergency department (ED) morbidity and mortality.

Methods: As part of the strategic plan, an Enterprise Pain Stewardship Committee formed in 2020 with the goal to improve safety and efficacy associated with pain management via staff education, compliance with regulatory standards, prospective surveillance of high-risk scenarios and direct patient care via an inpatient pain consult service. The multi-faceted approach included promotion of multimodal opioid-sparing practices, harm reduction, and increased access to MOUD. The primary clinical outcome was the rate of opioid-related ED encounters (defined as primary or secondary ICD10 code of F11* or T40*) across the enterprise in the 3 years after program implementation. Data were extracted from the electronic health record via a custom report. A Poisson regression was used for data analysis.

Results: During the 3-year period (May 2020-Mar 2023) there were 397,245 ED encounters across 8 EDs, of which 2,749 were opioid-related. A 37% reduction in opioid-related ED encounters (9.78 to 6.19 encounters per 1000 ED encounters, p< 0.001) was observed; more specifically the reduction was 22% for those prescribed an opioid by our institutions providers (1.61 to 1.26 per 1000 ED encounters, p=0.067). A 48% reduction in opioid mortality rate (0.197 to 0.103 deaths per 1000 ED encounters, p=0.038) was observed.

Conclusions: The multifaceted approach to pain stewardship, which yielded improvement in surrogate metrics, was also associated with improvements in morbidity and mortality during the same time period.