Brief Provider Education is Associated with Decreased ED Visits by Super-utilizers.

Abstract

Background: Millions of adult visits to emergency departments (EDs) each year are opioid-related, and those who visit with chronic pain are more likely to be super-utilizers (SUs) of the ED. Although SUs comprise 5% of the general population, they account for 50% of health care expenditure.

Objective: Determine whether brief provider opioid education results in decreased number of SUs and total ED visits by SUs.

Methods: The American Academy of Emergency Medicine's ED Opioid Prescribing Guidelines were presented to five EDs (estimated total 70,000 ED annual patient volume). ICD-10 codes from visits one year before and after the education were evaluated for painful diagnoses and identified patients who fit the definition of SU. Statistical analysis was performed on the data using McNemar's test and Z-scores.

Results: A statistically significant decrease (p=0.0006) in patients who visited the ED more than once after the education compared to prior to the education (n=304) was found. A statistically significant decrease (p=0.0017) in total number of visits after the education (n=268) by SU patients was found. No statistically significant change in visits made by non-SU patients (p=1.9983), nor average number of visits made by SUs (p=0.2320) was found.

Conclusion: Providing opioid education to ED providers was associated with a significant reduction in number of SUs visiting the ED and number of visits made by SUs. Based on average costs of ED visits by SUs, this decrease in visits can be correlated to an estimated savings of over $1 million across five EDs.