Nudges for Opioid Reduction After Major Surgery Trial

Study Overview
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Brief Summary
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This is a prospective pilot trial to evaluate a new electronic medical record based intervention to improve discharges after surgery. The investigators hypothesize that standard discharge medications after surgery will help to optimize opioid prescribing and potentially decrease healthcare utilization in the first 30 days after surgery.

Detailed Description
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This is a 2-arm parallel randomized trial comparing a new electronic medical record (EMR)-based intervention to usual care after surgery. All patients will receive their usual peri- and intraoperative care. Then, upon discharge, their providers will see the new EMR-based discharge order set (intervention arm) or not (usual care). The investigators hypothesize that standard discharge medication order sets after surgery will help to optimize opioid prescribing and potentially decrease healthcare utilization in the first 30 days after surgery.

Official Title
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Nudges for Opioid Reduction After Major Surgery

Conditions
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Surgery

Intervention / Treatment
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* Behavioral: Electronic Medical Record Based Discharge Medication Order Set


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patients Aged 18 and over Undergo selected general surgical procedures Exclusion Criteria: Less than 18 years of age

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: 2 arm parallel, cluster-randomized trial
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention<br>New electronic medical record based discharge medication order set. | Behavioral: Electronic Medical Record Based Discharge Medication Order Set<br>* New medication discharge order set including recommended opioid quantities, adjunct pain medication<br>|
| No Intervention: Control<br>Usual Care | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total Discharge Opioid Burden | Morphine milligram equivalents in the initial discharge prescription after index surgery | Immediately after study intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Additional Opioid Burden within 30 days | Morphine milligram equivalents on any additional opioid prescription within 30 days of discharge | Within 30 Days | 
| Proportion of cases with Phone Calls to Surgery Department | Phone calls to surgery department within 30 days of discharge | Within 30 Days | 
| Proportion of Cases with Emergency Room Visits | ER visits within 30 days of discharge | Within 30 Days | 
| Proportion of Cases with Hospital Readmissions to a Surgical Service | Readmissions to surgical service within 30 days of discharge | Within 30 Days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Surgery, Discharge, Hospital Systems, Electronic Medical Record, Opioids, Prescription