By: Saparja Nag  Nov. 13, 2017
This research with Harvard was published in the American Journal of Medical Quality
Dexur & Harvard Medical School Researchers Submitted Poster
The United States federal government recently declared the opioid epidemic as a national public health emergency. One of the most common uses of opioids is for inpatient post surgical pain management; however, usage of opioids is associated with a number of unfavorable outcomes. Factors that are commonly associated with ORADEs such as respiratory depression, ileus, post operative nausea, and vomiting impact a number of quality outcomes. These quality outcomes include increased length of stay, cost, readmission rates, and mortality. For example, a study by Oderda et al. in 2003 estimated that the common ORADES respiratory depression and urinary retention had a cost of $626 & $777 respectively in selected surgical patients.2
In addition to the implications of ORADEs on patient quality outcomes, value-based purchasing payment programs also motivate hospitals to reduce costs. Furthermore, there are increasingly regulatory guidelines including the Joint Commission Proposed Standards on pain assessment and management that emphasizes safe use of opioids as a key focus area3. Due to costs associated with opioids, patient quality outcomes, and regulatory guidelines, hospitals are now developing opioid stewardship programs to manage the use of opioids4.
However, despite the strategic need to implement safe use of opioids and manage ORADES, hospitals have found it challenging to implement practical ongoing monitoring programs to operationally measure the outcomes of their initiatives. To address this, a dashboard using Medicare administrative claims was developed to help hospitals evaluate their ORADE incidence rates and the quality impact of these ORADEs on key metrics such as LOS and cost.
The dashboard concept will be presented at ASRA’s 16th Annual Pain Medicine meeting from November 16th to 18th in Orlando, Florida. The American Society of Regional Anesthesia and Pain Medicine (ASRA) is one of the largest subspecialty medical societies in anesthesiology with more than 4,000 members in 60 countries and 6 continents. The abstract won the “Resident/Fellow Best of Meeting Abstracts and Research Travel Award”, which is only awarded to three submissions at the meeting.
Dexur’s research collaborators in this research study included:
Dr. Richard Urman MD, MBA, FASA is an anesthesiologist practicing in Boston, Massachusetts at the Brigham and Women's Hospital. His research interests include pharmacology, health services research, informatics, operating room efficiency, and patient safety. He has published numerous research articles and edited several books, including Pocket Anesthesia, Anesthesiology Student Survival Guide, The MGH Textbook of Anesthetic Equipment and Essential Clinical Anesthesia, Pocket Pain Medicine, Operating Room Leadership and Management, among others. He has lectured nationally and internationally, and he directs the Perioperative Medicine Fellowship and the Center for Perioperative Research.
Dr. Mark Jones is a resident physician training at the Beth Israel Deaconess Medical Center & a Clinical Fellow at the Harvard Medical School. He received his MD from Tulane University and BA from Louisiana State University. His prior publications on opioids have included a review of opioid abuse predictors and strategies to curb opioid abuse.
Dr. Alexander B Stone is a resident physician training at the Brigham and Women's Hospital. He received his MD from Johns Hopkins School of Medicine and BA from Amherst College. His clinical interests include perioperative medicine, quality improvement and enhanced recovery after surgery (ERAS) program implementation and maintenance.
Herzig et al. “Opioid Utilization and Opioid-Related Adverse Events in Non-Surgical Patients in U.S. Hospitals.” Journal of Hospital Medicine. Nov 2014; 9(2): 73-81. DOI: 10.1002/jhm.2102.
Oderda G, et al. “Cost of Opioid-Related Adverse Drug Events in Surgical Patients.” Journal of Pain and Symptom Management. Mar 2003; 25(3): 276-283. DOI: 10.1016/S0885-3924(02)00691-7.
“New and Revised Standards Related to Pain Assessment and Management - Joint Commission Requirements for Accredited Hospitals.” The Official Newsletter of The Joint Commission. Jul 2017; 37(7): 1-3. https://www.jointcommission.org/assets/1/18/Joint_Commission_Enhances_Pain_Assessment_and_Management_Requirements_for_Accredited_Hospitals1.PDF
Williams C. “Establishment of an Opioid Stewardship Program.” Virginia Society of Health-System Pharmacists. http://www.vshp.org/uploads/6/3/6/0/6360223/williams-opioid_1_per_page.pdf