Article Text

Download PDFPDF
Assessment of a quality improvement intervention to decrease opioid prescribing in a regional health system
  1. Craig S Brown1,2,
  2. Joceline V Vu1,2,
  3. Ryan A Howard1,2,
  4. Vidhya Gunaseelan2,
  5. Chad M Brummett2,3,
  6. Jennifer Waljee2,4,
  7. Michael Englesbe1,2
  1. 1 Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
  2. 2 Michigan Opioid Prescribing Engagement Network, Ann Arbor, Michigan, USA
  3. 3 Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
  4. 4 Department of Plastic Surgery, University of Michigan, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Craig S Brown, Surgery, University of Michigan, Ann Arbor, MI 48109, USA; brcraig{at}


Background Opioids are prescribed in excess after surgery. We leveraged our continuous quality improvement infrastructure to implement opioid prescribing guidelines and subsequently evaluate changes in postoperative opioid prescribing, consumption and patient satisfaction/pain in a statewide regional health system.

Methods We collected data regarding postoperative prescription size, opioid consumption and patient-reported outcomes from February 2017 to May 2019, from a 70-hospital surgical collaborative. Three iterations of prescribing guidelines were released. An interrupted time series analysis before and after each guideline release was performed. Linear regression was used to identify trends in consumption and patient-reported outcomes over time.

Results We included 36 022 patients from 69 hospitals who underwent one of nine procedures in the guidelines, of which 15 174 (37.3%) had complete patient-reported outcomes data following surgery. Before the intervention, prescription size was decreasing over time (slope: −0.7 tablets of 5 mg oxycodone/month, 95% CI −1.0 to −0.5 tablets, p<0.001). After the first guideline release, prescription size declined by −1.4 tablets/month (95% CI −1.8 to −1.0 tablets, p<0.001). The difference between these slopes was significant (p=0.006). The second guideline release resulted in a relative increase in slope (−0.3 tablets/month, 95% CI −0.1 to −0.6, p<0.001). The third guideline release resulted in no change (p=0.563 for the intervention). Overall, mean (SD) prescription size decreased from 25 (17) tablets of 5 mg oxycodone to 12 (8) tablets. Opioid consumption also decreased from 11 (16) to 5 (7) tablets (p<0.001), while satisfaction and postoperative pain remained unchanged.

Conclusions The use of procedure-specific prescribing guidelines reduced statewide postoperative opioid prescribing by 50% while providing satisfactory pain care. These results demonstrate meaningful impact on opioid prescribing using evidence-based best practices and serve as an example of successful utilisation of a regional health collaborative for quality improvement.

  • clinical practice guidelines
  • continuous quality improvement
  • health policy
  • patient satisfaction
  • quality improvement

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Twitter @MichaelEnglesbe

  • Funding National Institute on Drug Abuse (5 R01 DA 042859 03) and Michigan Department of Health and Human Services (E20203204-00, E20203205-00, E20203206-00, E20203373-00 and E20203374-00).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Owing to the use of data for quality improvement as well as the deidentified nature of the data, the institutional review board at the University of Michigan, Ann Arbor, Michigan, USA, deemed this study exempt from approval.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement Data are available on reasonable request. Data belong to the Michigan Surgical Quality Collaborative and are available on reasonable request to Kathy Bishop at the following email address:

Linked Articles