Background: The number of drug overdose deaths in the United States has never been higher and over 75% of these deaths involved opioids. Hospitalists contribute to opioid initiation for millions of patients a year and, just last year, Internal Medicine (IM) residents at our institution prescribed 479 new opioid prescriptions to patients discharging from the hospital. Multiple agencies recommend that hospitalists limit new opioid prescriptions on discharge to 7 days or less to reduce the risks of misuse and diversion. Thus, reducing opioid duration on discharge is critical and residents must adjust their prescription patterns to address the growing and costly opioid epidemic. The Graduate Medical Education Quality and Safety Bonus Program at our institution provides annual monetary support for residents to achieve and engage in high priority quality improvement projects. Our metric, chosen by IM residents, focused on decreasing the number of opioids prescribed on discharge.
Purpose: The aim of this project is to demonstrate how our IM residency program has engaged residents to curb the opioid crisis by reducing opioid prescribed for more than 7 days on discharge at two teaching hospitals over an 8-month period.
Description: To start, we built a team of stakeholders and created a data dashboard to track the primary outcome—the number of opioid prescriptions prescribed for more than 7 days on discharge. We included prescriptions for patients discharged from IM teaching services at participating hospitals, excluding patients with active cancer and/or an opioid prescription prior to admission. Our primary outcome baseline showed that over a 12-month period, 28% (135 out of 479) of opioid prescriptions were written for more than 7 days.
IM residents then collectively chose a tiered system to measure achievement in decreasing the frequency of our primary outcome: less than 35% of discharges for the first 3 months, less than 15% for the next 3 months, and less than 10% for the remaining 2 months of the initiative.
Interventions included disseminating monthly data during scheduled IM resident meetings and uploading the data graphics to each resident’s evaluation dashboard. Furthermore, resident ownership and engagement was fostered by providing mentorship and resources to make improvements. For instance, using data provided by program coordinators, residents are conducting a root cause analysis to evaluate opioid prescription duration longer than 7-days. To date, these interventions have had a notable impact and residents have met their first goal.
Conclusions: Resident ownership and engagement are key to decreasing the length of new opioid prescriptions on discharge, a critical step in tackling the opioid epidemic.