Intermountain Healthcare is an internationally recognized, integrated, not-for-profit health system based in Salt Lake City, Utah, (USA) with 33 Hospitals, (includes ‘virtual’ hospital), 385 Ambulatory Care Centers (clinics), approximately 3,900 employed physicians and advanced practice providers, and a health insurance company, Select Health, which covers more than 1.2 million lives. Intermountain is widely recognized as one of the premier healthcare systems in the United States and as a leader in transforming healthcare through high-quality clinical outcomes and efficient healthcare delivery at a sustainable cost.
In this case study addressing opioid use during the perioperative and home settings, Intermountain Healthcare recognized a significant problem within our communities. With surgery being among the top indications for opioid initiation and 6% of opioid naïve patients developing dependence and the disease of addiction, a culture shift with changes to clinical practice are needed.
The scope of this work was to capture the entire patient experience, preoperative, intraoperative, home, by introducing opioid sparing modalities in the workflows. With the opioid crisis underway we began looking at strategies to reduce home opioid prescriptions. The first milestone was Intermountain Healthcare’s recognition for the need of actual patient data to determine the role for perioperative opioid use. To capture both electronic and paper prescriptions written, a patient survey was developed to determine the opioid prescribed, quantity, dose, frequency, tablets consumed, and the patient’s opioid exposure preoperatively. With this data Intermountain Healthcare developed an app called Opioid Rx for ‘Data on the Go’ which allows providers to filter procedure specific opioid recommendations by surgical specialty, +/- procedure group, and procedure to see surgery specific opioid requirements for both opioid naïve and exposed patients. The Opioid RX app data was then built into the EHR by with procedure specific prescriptions and incorporated into surgeon clinic and discharge workflows.