Purpose: We created a hospital-wide initiative called the “Brigham Comprehensive Opioid Response and Education” (B-CORE) program to reduce opioid-related morbidity and mortality in an efficient, comprehensive, and multi-disciplinary fashion.
Description: In early 2016, we convened an executive committee of hospital leaders to empower and launch the program. This group included the CMOs of both the hospital and the physicians’ organization, CQO, CNO, chairs of Anesthesiology, Psychiatry, director of resident graduate medical education, director of pharmacy, and other key decision-makers. Once launched, the executive committee commissioned two task forces: (1) prescribing and (2) addiction. The prescribing task force developed outpatient opioid prescribing guidelines for acute and chronic pain patients. The addiction task force worked to improve access to care for patients with substance use disorder (SUD). We involved hospitalists and other inpatient providers from the onset to optimize treatment of pain for hospitalized patients via the projected to Reduce Adverse Drug Events Related to Opioids (RADEO). In less than a year, B-CORE has created: (1) an umbrella organization for opioid-related projects throughout the hospital, (2) prescribing guidelines for hospital-wide dissemination, and (3) opioid prescribing benchmark reports to find outlier prescribers. We are working to improve resources for patients with SUD by increasing the number of providers who can prescribe buprenorphine, widely disseminating naloxone, and providing medication-assisted treatment to inpatients with SUD. Education, community outreach, and research are key future provisions of the B-CORE program. We are creating a regular opioid grand rounds program, have engaged community patient/family groups, and identified tangible, meaningful measures for program outcomes and effectiveness analysis (Table 1).
Conclusions: Given the momentum of the opioid overdose crisis and calls for hospital providers to curb overdose deaths, we offer our program as a model for any facility. Keys to success are early buy-in and legitimization of the program via executive sponsorship, ensuring that the program does not belong to any one department or faction in the hospital, involving both inpatient and outpatient providers, creating an environment that empowers cross-disciplinary collaboration and welcomes anyone who wants to work to solve the problem, and development of measures for program outcomes and effectiveness analysis (Table 1).