scholarly journals Effect of the Strengthening Opioid Misuse Prevention (STOP) Act on Opioid Prescription Practices After Ankle Fracture Fixation

2019 ◽  
Vol 4 (4) ◽  
pp. 247301141988902
Author(s):  
S. Hanif Hussaini ◽  
Kevin Y. Wang ◽  
T. David Luo ◽  
Aaron T. Scott
Keyword(s):  
North Carolina ◽  
Ankle Fractures ◽  
Opioid Misuse ◽  
Level Of Evidence ◽  
Opioid Prescription ◽  
Prescription Practices ◽  
Prevention Act ◽  
Before And After ◽  
Operative Fixation ◽  
Ed Visits

Background: In North Carolina, the Strengthen Opioid Misuse Prevention Act of 2017 (STOP Act) went into effect on January 1, 2018, intending to increase oversight over opioid prescriptions. This study compares postoperative narcotic prescription practices following operative fixation of ankle fractures before and after the STOP Act. Methods: This study was a retrospective review of patients 18 years and older who underwent operative fixation of ankle fractures between January 1 and June 30, 2017 (before STOP Act), and between January 1 and June 30, 2018 (after STOP Act). Variables of interest included demographics, amount of opioids prescribed postoperatively, number of prescription refills, and number of pain-related calls or visits to the emergency department (ED) or clinic after surgery. This study assessed 71 patients in the Pre group and 47 patients in the Post group. Results: There was a statistically significant decrease in the average number of postoperative narcotic pills prescribed after the STOP Act (52.7 vs 76.2, P < .001). There was also a statistically significant decrease in the average number of prescription refills (0.6 vs 1.0, P = .037). There were no significant changes in pain-related clinic calls (35.2% Pre vs 34.0% Post, P = .896), pain-related clinic visits ahead of schedule (4.2% Pre vs 6.4% Post, P = .681), or pain-related ED visits (2.8% Pre vs 10.6% Post, P = .113). Conclusion: In the postoperative period after operative fixation of ankle fractures, the volume of narcotic prescriptions decreased after the new legislation, without an associated strain on medical resources. Level of Evidence: Level III, therapeutic, comparative study.

scholarly journals Opioid prescription practices for patients discharged from the emergency department with acute musculoskeletal fractures

CJEM ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. 486-493
Author(s):  
Garrick Mok ◽  
Hailey Newton ◽  
Lisa Thurgur ◽  
Marie-Joe Nemnom ◽  
Ian G. Stiell
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Prescription Data ◽  
Care Hospital ◽  
Total Dosage ◽  
Opioid Prescription ◽  
Prescription Practices ◽  
Ed Visits

ABSTRACTBackgroundOpioid related mortality rate has increased 200% over the past decade. Studies show variable emergency department (ED) opioid prescription practices and a correlation with increased long-term use. ED physicians may be contributing to this problem. Our objective was to analyze ED opioid prescription practices for patients with acute fractures.MethodsWe conducted a review of ED patients seen at two campuses of a tertiary care hospital. We evaluated a consecutive sample of patients with acute fractures (January 2016–April 2016) seen by ED physicians. Patients admitted or discharged by consultant services were excluded. The primary outcome was the proportion of patients discharged with an opioid prescription. Data were collected using screening lists, electronic records, and interobserver agreement. We calculated simple descriptive statistics and a multivariable analysis.ResultsWe enrolled 816 patients, including 441 females (54.0%). Most common fracture was wrist/hand (35.2%). 260 patients (31.8%) were discharged with an opioid; hydromorphone (N = 115, range 1–120 mg) was most common. 35 patients (4.3%) had pain related ED visits <1 month after discharge. Fractures of the lumbar spine (OR 10.78 [95% CI: 3.15–36.90]) and rib(s)/sternum/thoracic spine (OR 5.46 [95% CI: 2.88–10.35)] had a significantly higher likelihood of opioid prescriptions.ConclusionsThe majority of patients presenting to the ED with acute fractures were not discharged with an opioid. Hydromorphone was the most common opioid prescribed, with large variations in total dosage. Overall, there were few return to ED visits. We recommend standardization of ED opioid prescribing, with attention to limiting total dosage.

scholarly journals Patterns in Opioid Prescription for Patients Operatively Treated for Ankle Fractures Following Implementation of 2017 Ohio Opioid Prescriber Law

2019 ◽  
Vol 4 (4) ◽  
pp. 247301141989107 ◽  
Author(s):  
Georgina Glogovac ◽  
Jamal Fitts ◽  
Jordan Henning ◽  
Tonya L. Dixon ◽  
Richard T. Laughlin
Keyword(s):  
Comparative Study ◽  
Postoperative Period ◽  
The State ◽  
Downward Trend ◽  
Ankle Fractures ◽  
State Law ◽  
Postoperative Patient ◽  
Level Of Evidence ◽  
Opioid Prescription ◽  
Patient Cohort

Background: The purpose of this study was to report patterns of opioid prescription for patients treated operatively for ankle fractures after implementation of the 2017 Ohio Opioid Prescriber Law in comparison to the previous year. Methods: A total of 144 patients operatively treated for isolated ankle fractures during two 6-month periods, January 2017 to July 2017 (pre-law) and January 2018 to July 2018 (post-law), were retrospectively identified. Preoperative and postoperative patient narcotic use was reviewed using a legal prescriber database. Total number of prescriptions, quantity of pills, and morphine milligram equivalents (MMEs) per patient prescribed during the 90-day postoperative period were compared between those treated before and those treated after implementation of the Ohio prescriber law. Results: The average number of opioid prescriptions prescribed per patient in the 90-day postoperative period was 2.3 in the pre-law group and 2.1 in the post-law group ( P = .625). The average MMEs prescribed per patient dropped from 942.4 MME pre-law to 700.5 MME post-law ( P = .295). Differences in the average number of pills per prescription pre- and post-law (49.7 vs 36.2) and average MME per prescription (382.1 mg vs 275.2 mg) were statistically significant ( P < .001 and P = .016, respectively). Conclusion: Following the implementation of the 2017 Ohio Opioid Prescriber Law, there was a downward trend in the number of pills per prescription and MMEs per prescription in patients operatively treated for isolated ankle fractures. The presence of a downward trend in the quantity of opioids prescribed in this patient cohort suggests the effectiveness of the state law. Level of Evidence: Level III, comparative study.

scholarly journals Advances in the Surgical Management of Ankle Fractures

2019 ◽  
Vol 4 (4) ◽  
pp. 247301141988850 ◽  
Author(s):  
David J. Wright ◽  
Jason T. Bariteau ◽  
Andrew R. Hsu
Keyword(s):  
Intramedullary Nailing ◽  
Operative Management ◽  
Ankle Fractures ◽  
Deltoid Ligament ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Orthopedic Surgeons ◽  
Posterior Malleolus ◽  
Operative Indications ◽  
Operative Fixation

Ankle fractures are one of the most common injuries treated by orthopedic surgeons worldwide. However, operative indications, techniques, and reported outcomes following operative fixation vary widely in the literature. This evidence-based review focuses on recent advances in the operative management of ankle fractures including arthroscopic-assisted surgery, deltoid ligament complex repair, expanded indications for posterior malleolus fixation, fibula intramedullary nailing, and dynamic syndesmosis repair. Level of Evidence: Level V, expert opinion.

Asthma-Related Emergency Department Visits in North Carolina Following Hurricane Irene

2021 ◽  
pp. 1-4
Author(s):  
Kristen N. Cowan ◽  
Audrey F. Pennington ◽  
Kanta Sircar ◽  
W. Dana Flanders
Keyword(s):  
Emergency Department ◽  
North Carolina ◽  
Generalized Linear Model ◽  
Emergency Department Visits ◽  
Hurricane Irene ◽  
Asthma Exacerbations ◽  
Before And After ◽  
Ed Visits ◽  
Disaster Declarations ◽  
Using Data

Abstract Objective: Previous research suggests that people with asthma may experience a worsening of symptoms following hurricanes due to changes in environmental exposures, discontinuity in chronic disease management, and stress. The objective of this study was to estimate changes in asthma-related emergency department (ED) visits in North Carolina following Hurricane Irene, which made landfall in August 2011. Methods: Changes in asthma-related ED visits in September to December of 2010 and 2011 were examined using data from the Healthcare Cost and Utilization Project State Emergency Department and Inpatient Databases. A Poisson generalized linear model was used to estimate the association between Federal Emergency Management Agency disaster declarations following Hurricane Irene and county-level asthma-related ED visits controlling for month, year, and county. Results: Following Hurricane Irene, disaster declarations were made for 38 of 100 counties in North Carolina. In September 2010, the rate of asthma-related ED visits for North Carolina was 6 per 10,000 person-months. In September 2011, rates of asthma-related ED visits were similar in counties with and without disaster declarations (7 and 5 per 10,000 person-months, respectively). When adjusting for covariates, there was little or no difference in the rate of asthma ED visits before and after the hurricane between counties with and without a disaster declaration (rate ratio {RR} [95% confidence interval {CI}] = 1.02[0.97, 1.08]). Conclusions: Although risk factors for asthma exacerbations increase following hurricanes, these results found little evidence of an increase in asthma-related ED visits in North Carolina following Hurricane Irene.

Evaluation of a state law on opioid-prescribing behaviour and the void affecting codeine-containing antitussive syrup

2020 ◽  
pp. emermed-2019-209008
Author(s):  
Warren M. Perry ◽  
Chris B. Agala ◽  
Erika M. Agala
Keyword(s):  
North Carolina ◽  
Logistic Regression ◽  
Acute Pain ◽  
Opioid Misuse ◽  
Opioid Prescription ◽  
Opioid Medication ◽  
The North ◽  
Prescribing Behaviour ◽  
Regression Techniques ◽  
The Difference

BackgroundGovernment opioid policies—such as the North Carolina Strengthen Opioid Misuse Prevention (STOP) Act—have aided in lowering the days’ supply of opioid prescriptions. However, what effect do these laws have on codeine-containing antitussive syrup? We aimed to assess the effect of the North Carolina STOP Act on ED opioid prescriptions written for >5 days for acute pain/non-pain diagnoses and whether it had an effect on the prescribing of codeine-containing antitussive syrup.MethodsA retrospective study of two emergency departments, with an average annual census of 70 000 and 22 000 patients, from January to August of 2017 and 2018. We applied logistic regression techniques to calculate the odds of an opioid prescription for >5 days. Opioid medication categories were formed to determine relational proportions. Two-tailed z-tests were used to test the difference in proportions.ResultsOur study included 5366 verifiable opioid prescriptions. The percentage of an opioid prescription for >5 days decreased by 3.3% (95% CI −1.8% to −4.7%, p<0.05) after the North Carolina STOP Act (9.8% to 6.5%; 95% CI 5.5% to 7.5%, p<0.05). There was no statistically significant change in the prescribing of codeine syrup for >5 days pre-STOP and post- STOP Act, respectively (91.5% and 90.4%; difference=−1.1%, p=0.83).ConclusionThe North Carolina STOP Act was associated with a reduction in the overall percentage of opioid prescriptions for >5 days for acute pain/non-pain diagnoses. However, there was no statistically significant effect on the prescribing of codeine-containing antitussive syrup.

Efficacy of the North Carolina Strengthen Opioid Misuse Prevention (STOP) Act in Reducing Opioid Prescription in Hand Surgery

2020 ◽  
Vol 231 (4) ◽  
pp. S224
Author(s):  
Yifan Guo ◽  
Chelsea Morgan Viscardi ◽  
Karen M. Buckley ◽  
William Irish ◽  
Richard Stephen Zeri
Keyword(s):  
North Carolina ◽  
Hand Surgery ◽  
Opioid Misuse ◽  
Opioid Prescription ◽  
The North

Abstract 045: Declines In Acute Myocardial Infarction And Stroke Emergency Department Visits Observed During Covid-19 Restrictions In North Carolina

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Eugenia Wong ◽  
Wayne D Rosamond ◽  
Mehul D Patel ◽  
Anna Waller
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Emergency Department ◽  
North Carolina ◽  
Hospital Admissions ◽  
Emergency Department Visits ◽  
Syndromic Surveillance System ◽  
Before And After ◽  
Ed Visits ◽  
At Home

Introduction: Efforts to control the COVID-19 pandemic brought sweeping social change, with stay-at-home orders and physical distancing mandates in 43 of 50 states by April 2020. Early on, isolated studies around the world described reduced hospital admissions. Reports from some US hospitals also described declines in catheterization laboratory activations, and acute myocardial infarction (AMI) and stroke admissions. However, there have been few population-based analyses of emergency department (ED) visits to verify these initial reports and describe longer term impacts of the pandemic on care seeking behavior. Hypothesis: We hypothesized that AMI and stroke ED visits in North Carolina (NC) would decrease substantially after a statewide stay-at-home order was announced on March 27, 2020. Methods: We analyzed all ED visits from January 5 to August 28, 2020 using data collected by the NC Disease Event Tracking and Epidemiologic Collection Tool, a syndromic surveillance system that automatically gathers ED data in near-real time for all EDs in NC. Counts of AMI and stroke/transient ischemic attack (TIA) were ascertained using ICD-10-CM diagnosis codes. We compared weekly 2020 ED visit data before and after NC’s stay-at-home order, and to 2019 ED visit data. Results: Overall ED volume declined by 44% in the weeks before and after the stay-at-home order ( Figure ) while the prior year’s ED volume stayed steady at ~100,000 visits per week. From January 5 to March 28, there were 593 AMI and 791 stroke/TIA visits per week on average. By April 11, ED visits reached a nadir at 426 AMI and 543 stroke/TIA visits per week, representing a 28% and 31% decrease, respectively. Since June, AMI and stroke/TIA ED visits have rebounded slightly but have yet to reach pre-pandemic levels. Conclusions: We observed swift declines in AMI and stroke/TIA ED visits following NC’s stay-at-home order. These findings potentially reflect the avoidance of medical care due to fears of COVID-19 exposure and may eventually result in higher associated case fatality.

scholarly journals Evaluation of Emergency Health-Care Initiatives to Reduce Overcrowding in a Referral Medical Complex, Jeddah, Saudi Arabia

2021 ◽  
pp. 1-6
Author(s):  
Khalid Alabbasi ◽  
Estie Kruger ◽  
Marc Tennant
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Public Hospital ◽  
Waiting Times ◽  
Care Centre ◽  
Health Care Centre ◽  
Transfer Policy ◽  
Primary Health ◽  
Before And After ◽  
Ed Visits

<b><i>Purpose:</i></b> Excessive delays and emergency department (ED) overcrowding have become an increasingly major problem for public health worldwide. This study was to assess the key strategies adopted by an ED, at a public hospital in Jeddah, to reduce delays and streamline patient flow. <b><i>Materials and Methods:</i></b> This study was a service evaluation for a Saudi patient population of all age-groups who attended the ED of a public hospital for the period between June 2016 and July 2019. The Saudi initiative to reduce the ED visits at the King Abdullah Medical Complex hospital has started on August 7, 2018. The initiative was to apply an urgency transfer policy which outlines the procedures to follow when patients arrive to the ED where they are reviewed based on the Canadian Triage and Acuity Scale (CTAS). Patients with less-urgent conditions (category 4 and 5) are referred to a primary health-care practice (where a family medicine consultant is available). Patients with urgent conditions (category 1–3) are referred to a specialized health-care centre if the service is not currently provided. To test the effectiveness of ED initiative on reducing the overcrowd, data were categorized into before and after the initiative. The bivariate analysis χ<sup>2</sup> tests and 2 sample <i>t</i>-tests were run to explore the relationship of gender and age with dependent variable emergency. <b><i>Results:</i></b> A total of 233,998 patients were included in this study, 61.8% of them were males and the average age of ED patients were 35.5 ± 18.6 years. The majority of cases were those classified as “less urgent” (CTAS 4), which accounted for 65.4%. Number of ED visits before and after the initiative was 67 and 33%, respectively. ED waiting times after the initiative have statistically significantly decreased across all acuity levels compared to ED waiting times before the initiative. <b><i>Conclusion and Implication:</i></b> The findings suggest that the majority of patients arrive to the ED with less-urgent conditions and arrived by walking-in. The number of cases attending the ED significantly decreased following the introduction of the urgency transfer policy. Referral for less-urgent patients to primary health-care centre may be an important front-end operational strategy to relieve congestion.

scholarly journals Quantification and Comparison of Talar Exposure Utilizing a Posteromedial Approach and Medial Malleolar Osteotomy

2021 ◽  
Vol 6 (2) ◽  
pp. 247301142110126
Author(s):  
Jeffrey Donahue ◽  
Ademola Shofoluwe ◽  
Kurt Krautmann ◽  
Emilio Grau-Cruz ◽  
Stephen Becher ◽  
...  
Keyword(s):  
Surface Area ◽  
Digital Image ◽  
National Institutes Of Health ◽  
Level Of Evidence ◽  
Posterior Process ◽  
Medial Malleolar Osteotomy ◽  
Fresh Frozen ◽  
Average Quantity ◽  
Operative Fixation ◽  
Imagej Software

Background: Fractures of the talus are a rare but challenging injury. This study sought to quantify the area of osseous exposure afforded by a posteromedial approach to the talus and medial malleolar osteotomy. Methods: Five fresh-frozen cadaveric lower extremities were dissected using a posteromedial approach and medial malleolar osteotomy respectively. Following exposure, the talar surfaces directedly visualized were marked and captured using a calibrated digital image. The digital images were then analyzed using ImageJ software (National Institutes of Health) to calculate the surface area of the exposure. Results: The average square area of talus exposed using the posteromedial approach was 9.70 cm2 (SD = 2.20, range 7.20-12.46). The average quantity of talar exposure expressed as a percentage was 9% (SD = 1.58, range 7.03-10.40). The average square area of talus exposed using a medial malleolar osteotomy was 14.32 cm2 (SD = 2.00, range 11.26-16.66). The average quantity of talar exposure expressed as a percentage was 12.94% (SD = 1.79, range 9.97-14.73). The posteromedial approach provided superior visualization of the posterior talus, whereas the medial malleolar osteotomy offered greater access to the medial body. Conclusion: The posteromedial approach and medial malleolar osteotomy allow for significant exposure of the talus, yielding 9.70 and 14.32 cm2, respectively. Given the differing portions of the talus exposed, surgeons may prefer to use the posteromedial approach for operative fixation of posterior process fractures and elect to use a medial malleolar osteotomy in cases requiring more extensive medial and distal exposure for neck or neck/body fractures. Level of Evidence: Level IV.

Sign in / Sign up

Export Citation Format

Share Document