Adopting best practices in post-operative analgesia prescribing in a safety-net hospital: Residents as a conduit to change

Am J Surg. 2020 Feb;219(2):299-303. doi: 10.1016/j.amjsurg.2019.12.023. Epub 2019 Dec 21.

Abstract

Background: Safety-net hospitals frequently underperform on surgical quality measures. To achieve equitable surgical care, creative strategies are needed to improve care for this vulnerable population.

Methods: We designed a trainee-led quality improvement (QI) program to promote evidence-based analgesia prescribing. The program included a collaborative resident leadership model and used educational interventions and performance feedback.

Results: Before the QI program, 48% of patients were discharged on acetaminophen post-operatively, and 0% were discharged on ibuprofen. In the most recent month since the QI program was launched, 100% of patients were discharged on acetaminophen, and 81% on ibuprofen.

Conclusion: Our trainee-led quality improvement program demonstrates that surgical trainees can accelerate change and may be a powerful force for improving health equity through safer post-operative discharge prescribing practices at a safety-net hospital.

Keywords: Graduate medical education; Integrated learning systems; Opioids; Pain management; Postoperative drug therapy; Quality improvement.

MeSH terms

  • Adult
  • Analgesics, Opioid / therapeutic use*
  • Drug Utilization
  • Education, Medical, Graduate / methods
  • Evidence-Based Medicine / education*
  • Female
  • Humans
  • Internship and Residency / methods
  • Male
  • Opioid Epidemic / prevention & control*
  • Pain Management / methods
  • Pain, Postoperative / diagnosis
  • Pain, Postoperative / drug therapy*
  • Practice Guidelines as Topic
  • Quality Improvement*
  • Risk Assessment
  • Safety-net Providers / organization & administration*
  • United States

Substances

  • Analgesics, Opioid