The Impact of Alternative to Opioids (ALTO) Protocol on Opioid Reduction in the Community Emergency Department ¿ and the Impact of the COVID?19 Pandemic on the ALTO Protocol for Opioid Reduction in the Emergency Department

Abstract

Research Question: In patients visiting the Emergency Department (ED), is an Alternative To Opioid (ALTO) protocol for pain management effective in reducing opioid administration in the ED?

Background and Significance: The Alternatives to Opioids (ALTO) approach utilizes non?opioid medications for pain management to ultimately diminish opioid utilization in the emergency department (ED).

Materials and Methods: This retrospective, single center, cohort study investigates the impact of the ALTO protocol on opioid use, patient satisfaction with pain control, and subsequent ED flow. Patients receiving pain medication in an urban level three trauma center from March to August of 2018 prior to implementation of the ALTO protocol were identified as the pre?protocol control group and patients receiving pain medication between March to August 2019 after implementation of the protocol in the same ED were allocated to the postprotocol group. The primary interest of the study was the effect on opioid use in the ED. The secondary outcomes investigated were door?to?doctor time, the left without being seen (LWOBS) rate, patient satisfaction with pain control, and the average turnaround time.

Results: Total opioid administration decreased by 59.6% in the post?protocol group. The LWOBS rate (p=0.003) and the average door?to?doctor time (p<0.001) were significantly decreased in this group as well. No significant difference in patient satisfaction to pain control (p=0.192) or average turnaround time (p=0.209) was identified between the groups.

Conclusion: ALTO protocol implementation was associated with a significant reduction in opioid administration without impacting patient satisfaction with pain control or ED flow.