860 A Novel Quality Improvement Initiative to Reduce Inpatient Opioid Analgesic Use in Inflammatory Bowel Disease: The “IBD Pain Ladder”

Abstract

INTRODUCTION: Opioid analgesic use is associated with increased mortality, higher readmission rates, and reduced quality of life among patients with inflammatory bowel disease (IBD). Evidence-based strategies to reduce inpatient opioid use in this population have been lacking. METHODS: We have initiated a quality improvement study using an educational intervention, targeting internal medicine (IM) and emergency medicine (EM) house staff with a goal to reduce in-hospital opioid use among IBD patients admitted to the gastroenterology (GI) service at our tertiary institution. This educational tool, the “IBD Pain Ladder” (Figure 1), was created using exhaustive literature review and with multi-disciplinary expert opinion. The tool is meant to help guide decisions regarding analgesia in this patient population while sparing opioid use. Pre-intervention data was collected from IBD patients admitted during a nine-month period (5/2018-2/2019). Educational intervention and prospective follow-up data for another 4 months was collected. The primary outcome was reduction in total inpatient opioid use in oral morphine equivalents per patient. Secondary outcomes included length of stay, types of opioid, 90-day readmission rates, outpatient opioid prescriptions provided upon discharge, Clostridium difficiledetection rates, fecal calprotectin, and C-reactive protein (CRP) levels. t tests for continuous variables and Fisher’s exact test for categorical variables were used; a P value < 0.05 was considered significant. RESULTS: A total of 51 patients with 69 hospitalizations were analyzed (Table 2). Hospitalizations before and after our intervention were compared. There was no statistically significant difference in baseline admission characteristics between the two groups (Table 1). Our primary outcome was achieved with a statistically significant reduction in opioid use (39.1 vs 12.4 mg; P < 0.037). Patients were also less likely to receive any opioid during hospitalizations after our intervention (71% vs 43%; P < 0.034.) Length of hospitalization (5.2 vs 3.9 days; P < 0.11) and readmission rates (41% vs 23.5%; P < 0.55) were decreased post-intervention but did not reach statistical significance. CONCLUSION: We believe this intervention, aimed at housestaff education and providing a roadmap for pain management in this patient population, is a cost-effective, readily reproducible strategy that can be widely applied to improve IBD patient care. Results will be published and used for quality improvement in inpatient IBD care.