Opioid Prescription Reduction After Implementation of a Feedback Program in a National Emergency Department Group

Abstract

Study objective: Reducing excessive opioid prescribing in emergency departments (ED) may prevent opioid addiction. We evaluated the largest personalized feedback and peer comparison intervention to date on emergency clinician opioid prescription rates in a national emergency clinician group.

Methods: This interrupted time series analysis of a quality improvement intervention included data from adults discharged from 102 EDs in 17 states from January 1, 2019, to July 31, 2021. From June 16, 2020, to November 30, 2020, site-level ED directors received emails on local opioid prescription rates. From December 1, 2020, to July 31, 2021, all clinicians were granted electronic dashboard access, which showed prescription rates compared with peers, and national ED leaders sent emails to high-prescribing clinicians and engaged in one-on-one conversations. The primary outcome was opioid prescriptions per 100 discharges.

Results: The study included 5,328,288 ED discharges from 924 physicians and 472 advanced practice providers. Opioid prescription rates did not change meaningfully in the site-level director feedback period (mean difference = -0.3, 95% confidence interval [CI] -0.6 to -0.1). During the direct clinician feedback period, opioid prescription rates declined from 10.4 per 100 discharges to 8.4 per 100 discharges (mean difference = -2.0, 95% CI -2.4 to -1.5), a 19% relative reduction. Among prescribers in the highest initial quintile, opioid prescribing reduced by 35% among physicians and 41% among advanced practice providers in the direct feedback period.

Conclusion: We demonstrated a large, sustained reduction in opioid prescribing by emergency clinicians using direct, personalized feedback to clinicians and an electronic dashboard for peer comparison.