Brief Provider Opioid Education Is Associated with Decreased Super-Utilization in a Rural Emergency Department

Patients who suffer chronic pain may seek the emergency department for opioids. There is no consensus on what constitutes an ED super-utilizer, so our definition is anyone who presented to the ED more than once for the same painful complaint. We sought to assess the effect of opioid guideline education for providers on super-utilizer visits for pain.

We performed a retrospective review of visits for chief complaints of pain one year before (phase one) and one year after (phase two) educating ED providers. The educational intervention consisted of a 20-minute explanation of the American Academy of Emergency Medicine's Model ED Pain Treatment Guidelines. McNemar's test was applied to the resultant data.

Phase one identified 218 super-utilizers accounting for 660 ED visits. Phase two identified 190 super- utilizers accounting for 604 ED visits. Both groups were stratified into those using the ED more than once, more than twice, and more than three times. There was a statistically significant difference in patients visiting the ED more than once (p=0.01) and more than three times (p=0.027), but not for those visiting more than twice (p=0.18). There was no statistically significant difference in total patient ED visits in any subgroup.

The total number of super-utilizers significantly decreased after the educational intervention. This educational intervention required minimal monetary and time investment. Further research is needed to determine if the educational intervention resulted in decreased opioid prescriptions and decreased number of people utilizing these drugs for non-medical purposes.