Effect of a targeted quality improvement education on opioid prescribing.

BACKGROUND: The opioid epidemic is a serious social, economic and public health problem. This study was designed to evaluate the effectiveness of individual institutional opioid prescriber training on prescriber adherence to the Centers for Disease Control and Prevention (CDC's) guidelines for responsible opioid prescribing practices to treat acute pain. METHODS: Opioid prescribing data were collected from an academic medical centre and its associated outpatient clinics. A baseline for opioid prescribing practices was collected for 2 years and 2 months prior to the planned intervention. Departments responsible for 5% or more of the total institutional opioid prescriptions were chosen to study in detail. A number of opioid prescriptions per department per day and their compliance with the maximum daily dose (MDD) recommendations put out by the CDC were determined. INTERVENTION: The hospital administration implemented a mandatory opioid prescriber training as part of their standard annual provider education for all medical staff, who were all required to attest having read it and pass a quiz by 30 September 2019, which was chosen as the end date for the pre-intervention data. Data were analysed preintervention and postintervention to assess the effect of this intervention on opioid prescribing. RESULTS: Overall opioid prescribing rates decreased by 18.3% and there were significant decreases in opioid prescribing rate in five out of the seven departments/divisions. Overall, there was a statistically significant decrease in the compliance with MDD before (71.3%) and after (67.3%) the intervention (4%, 95% CI 3.13% to 4.87% difference, p<0.001). Additionally, there were statistically significant increases in compliance with CDC guidelines in three departments/divisions. However, there was a statistically significant decrease in compliance with CDC guidelines after intervention in two departments. CONCLUSIONS: The results of this study were largely encouraging for the effectiveness of this institutional mandatory prescriber training.

The Current Status of Ultrasound Education in United States Medical Schools.

OBJECTIVES: Ultrasound is used by nearly every medical specialty. Medical schools are integrating ultrasound education into their curriculum but studies show this to be inconsistent. The purpose of this study was to provide an updated description of ultrasound in the curricula of United States Accredited Medical Schools (USAMS). METHODS: In 2019, USAMS curricular offices were contacted. Institutions were asked about the presence of ultrasound curriculum and for contact information for faculty involved with education. Schools reporting ultrasound curriculum were surveyed regarding details of their curriculum. RESULTS: Two hundred USAMS were contacted with a response rate of 84%. Of 168 schools, 72.6% indicated they have an ultrasound curriculum. For schools with a curriculum, 79 (64.8%) completed our survey. The majority of survey respondents, 66 (83.5%), indicated having mandatory ultrasound. Ultrasound is primarily integrated into courses (73.8% in basic science courses, 66.2% in clinical skills courses, and 35.4% in clinical rotations). Emergency medicine physicians accounted for 54.7% of course directors. Ten or fewer faculty participate in education in 68.4% of schools and mostly as volunteers. Dedicated machines for education were reported by 78.5% of schools. CONCLUSIONS: Compared to prior studies, this study had a higher response rate at 84%, and more schools reported ultrasound in their curricula. Emergency medicine represents the majority of leadership in ultrasound education. Despite increased integration of ultrasound into American medical school curricula, its instruction is still inconsistent.