Surgeons' Perspectives on Changing the Default Number of Doses for Opioid Prescriptions in Electronic Health Record Systems
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Updated: Jul 29, 2025
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Published on: June 11, 2012
Kao-Ping Chua1,2, Marc C Thorne3, Chad M Brummett4,5
1Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan Medical School, Ann Arbor.
Importance:
An intervention in 2021 at a tertiary medical center found that the implementation of evidence-based default dosing settings for opioid prescriptions written in electronic health record systems was associated with reduced opioid prescribing to adolescents and young adults aged 12 to 25 years undergoing tonsillectomy. It is unclear whether surgeons were aware of this intervention, whether they thought the intervention was acceptable, or whether they believed similar interventions were feasible to implement in other surgical populations and institutions.
Objective:
To assess surgeons' experiences and perspectives regarding an intervention that changed the default number of doses for opioid prescriptions to an evidence-based level.
Design, Setting, And Participants:
This qualitative study was conducted at a tertiary medical center during October 2021, 1 year after implementation of the intervention, in which the default number of doses for opioid prescriptions written through an electronic health record system to adolescents and young adults undergoing tonsillectomy was lowered to an evidence-based level. Semistructured interviews were conducted with otolaryngology attending and resident physicians who had cared for the adolescents and young adults undergoing tonsillectomy after implementation of the intervention. Factors that play a role in opioid prescribing decisions after surgery and participants' awareness of and views on the intervention were assessed. The interviews were coded inductively and a thematic analysis was performed. Analyses were conducted from March to December 2022.
Exposure:
Change in the default dosing settings for opioid prescriptions written in an electronic health record system to adolescents and young adults undergoing tonsillectomy.
Main Outcomes And Measures:
Surgeons' experiences and perspectives regarding the intervention.
Results:
The 16 otolaryngologists interviewed included 11 residents (68.8%), 5 attending physicians (31.2%), and 8 women (50.0%). No participant reported noticing the change in the default settings, including those who wrote opioid prescriptions with the new default number of opioid doses. From the interviews, 4 themes regarding surgeons' perceptions and experiences of the intervention emerged: (1) opioid prescribing decisions are influenced by patient, procedure, physician, and health system factors; (2) defaults may substantially influence prescribing behavior; (3) support for the default dosing setting intervention depended on whether it was evidence-based and had unintended consequences; and (4) changing the default dosing settings is potentially feasible in other surgical populations and institutions.
Conclusions And Relevance:
These findings suggest that interventions to change the default dosing settings for opioid prescriptions may be feasible to implement in a variety of surgical populations, particularly if the new settings are evidence-based and if unintended consequences are carefully monitored.
Insights
Surgeons did not notice changes to electronic health record opioid dosing defaults, but recognized defaults influence prescribing. Evidence-based defaults are feasible for reducing opioid prescribing in young patients.
Area of Science:
- Medical Informatics
- Pain Management
- Surgical Outcomes
Background:
- Electronic health record (EHR) default settings can influence opioid prescribing.
- Previous interventions reduced opioid prescriptions for tonsillectomy patients aged 12-25.
- Surgeon awareness and perspectives on these interventions were previously unknown.
Purpose of the Study:
- To evaluate surgeons' experiences with an EHR intervention that modified opioid prescription default dosing.
- To assess surgeon awareness, acceptance, and perceived feasibility of evidence-based opioid prescribing defaults.
Main Methods:
- Qualitative study using semistructured interviews with 16 otolaryngologists (residents and attending physicians).
- Interviews conducted one year post-intervention regarding opioid prescribing for tonsillectomy patients.
- Thematic analysis of interviews exploring prescribing factors, intervention awareness, and views on feasibility.
Main Results:
- No surgeons reported noticing the change in EHR default opioid settings.
- Four themes emerged: factors influencing prescribing, impact of defaults, conditional support for interventions, and feasibility of broader implementation.
- Surgeons acknowledged that defaults can significantly influence prescribing behavior.
Conclusions:
- Surgeons' lack of awareness did not preclude recognition of default settings' influence on prescribing.
- Evidence-based default opioid dosing interventions are potentially feasible across various surgical populations.
- Careful monitoring for unintended consequences is crucial for successful implementation.
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