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Individualized outcome feedback produces voluntary antiemetic prescribing practice changes
F J Overdyk1, S C Harvey, D Baldwin
1Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston 29425-2207, USA.
Journal of Clinical Anesthesia
|July 9, 1999
Summary
Individualized feedback reduced antiemetic costs by 48% without affecting patient satisfaction or postoperative nausea and vomiting (PONV) rates. A standardized protocol increased its use by 54%.
Area of Science:
- Anesthesiology
- Pharmacology
- Health Services Research
Background:
- Postoperative nausea and vomiting (PONV) remains a significant concern for patients undergoing general anesthesia.
- Current antiemetic prescribing practices vary, potentially impacting cost-effectiveness and patient outcomes.
- Standardized protocols may offer a cost-effective alternative to customized antiemetic therapy.
Purpose of the Study:
- To evaluate the impact of individualized outcome feedback on antiemetic prescribing patterns.
- To compare the outcomes of a standardized antiemetic protocol (PROT) versus customized therapy (NONPROT).
- To assess the cost-effectiveness and patient satisfaction associated with different antiemetic strategies.
Main Methods:
- Prospective, observational study with a randomized component involving 3027 patients receiving general anesthesia.
- Patients were randomized to a standardized protocol (PROT) using droperidol or ondansetron, or received customized antiemetic therapy (NONPROT).
- Outcomes measured included PONV incidence, patient satisfaction, antiemetic expenditures, and prophylaxis use over 4 months.
Main Results:
- The incidence of PONV was similar between the PROT (11%) and NONPROT (10%) groups.
- Ondansetron as first-line therapy showed a lower need for rescue medication (5%) compared to droperidol (14%), with no difference in patient satisfaction.
- Individualized feedback led to a 47% decrease in prophylaxis use and a 54% increase in PROT selection, sustained post-study.
Conclusions:
- Individualized outcome feedback significantly reduced monthly antiemetic expenditures by 48% for ondansetron and droperidol.
- Patient satisfaction was comparable between ondansetron and droperidol, despite ondansetron's slightly greater efficacy.
- A standardized antiemetic protocol, guided by outcome feedback, can improve cost-effectiveness without compromising patient satisfaction or PONV control.