Multimodal Intervention May Reduce Opioid Use in Patients With IBD Flares Presenting to the Emergency Department

Researchers examined a safe and evidence-based approach to effectively manage pain in patients with IBD flares presenting to the emergency department.

The following article is a part of conference coverage from the Advances in Inflammatory Bowel Diseases 2021 Annual Meeting , held from December 9 to 11, 2021. The team at Gastroenterology Advisor will be reporting on the latest news and research conducted by leading experts in gastroenterology. Check back for more from AIBD 2021.


A multimodal intervention approach could reduce opioid use in the emergency department (ED) for patients presenting with inflammatory bowel disease (IBD) flares, according to research presented at the Advances in Inflammatory Bowel Diseases (AIBD) 2021 Annual Meeting, held from December 9 to 11, 2021, in Orlando, Florida and virtually.

Opioid use is associated with severe side effects, mortality, and low quality of life among patients with IBD. Their use in the ED for acute IBD flares is not well documented. Researchers of the current study sought to examine a safe and evidence-based approach to effectively manage pain due to IBD flares.

The researchers conducted a retrospective analysis in a preintervention cohort of patients with IBD flares presenting between June 2019 and December 2019 at a tertiary academic center ED. They designed and performed a multimodal quality improvement intervention which included an evidence-based IBD pain guideline, customized electronic health record order-set, gastroenterology (GI) consultation note smart-phrase, and clinician education to promote opioid stewardship. The intervention was validated for efficacy in a postintervention cohort by repeating the retrospective analysis from December 2020 to April 2021.

The preintervention cohort included 71 patients. Opioids were prescribed to almost 80% of patients admitted to the ED with IBD flares. Nearly half of the patients did not receive nonopioid analgesics, with 13% receiving an opioid prescription during discharge. An average of 29.3 morphine milligram equivalents (MME) were administered per ED stay.

The postintervention cohort included 49 patients. A significant reduction in the proportion of patients receiving opioids and a significant decrease in the average total of opioids administered were reported (45% vs 78%; P <.001 and 10.8 vs 22.6 MME; P <.001, respectively). During each month of the postintervention period, the proportion of patients receiving opioids and the average total of opioids administered were less compared with the median of the entire study period, representing a nonrandom pattern. There was a significant increase in the use of the nonopioid analgesic intravenous acetaminophen (27% vs 3%; P <.001).

The risk of new or recurrent GI bleeding was low in both cohorts (0% vs 1%; P =1.0). No significant difference was observed between the average pain score (10-point scale, 4.9 vs 5.4; P =.440) and the difference between reported triage and final ED pain scores (-1.8 vs -2.0; P =.729). A significant reduction in GI consultation (35% vs 58%; P <.016) and a nonsignificant reduction in hospital admissions (63% vs 80%; P =.058) were also reported.

Researchers stated, “A multimodal intervention successfully reduced the proportion

and amount of opioid prescribing in the ED without compromising pain control or increasing the risk of GI bleeding.” “These findings support the role of implementing an evidence-based IBD pain management guideline with electronic prescribing support and education in the ED setting for acute IBD flares,” they concluded.

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Steven P, Elliot G, Edwin L, et al. Successful reduction in opioid prescription for IBD flare in the emergency department: a retrospective study and quality improvement initiative. Presented at: AIBD 2021 Annual Meeting; December 9-11, 2021; Orlando, FL and virtual. Abstract P041.