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Parenteral Opioid Effectiveness Assessment
The Mayday Fund
Intravenous opioids are the most effective analgesics for many of the painful conditions encountered by hospitalized and emergency patients. We previously documented that the current dosing of intravenous morphine, the most commonly used opioid in hospitalized patients, falls far below both current dosing guidelines and the doses of alternative opioids; these findings were independent of patient variables that would be expected to affect opioid dosing. The existing opioid dosing guidelines themselves do not have a strong evidence base linking opioid dosing with patient outcomes (analgesia and potential side effects). This project is a prospective, observational study assessing these outcomes in emergency patients who are prescribed intravenous morphine or an alternative. In addition, the study will evaluate a variety of prescriber and patient variables that might affect the choice of opioid and opioid dose, which will help us understand why these dosing irregularities exist. We intend to use the information from this study to design and then test interventions designed to improve opioid dosing and the resulting patient outcomes.
Improving Inpatient Medicine Curriculum
The inpatient Internal Medicine educational experience of residents and students has changed dramatically over the past few decades. Recent challenges to education have included the increasing complexity of inpatients, limitation of resident work hours, the creation of observation units, and the evolution of non-teaching medical services. Since the primary method of resident and student education is experiential, the patient population cared for by trainees is fundamental to the quality of their education. We are currently evaluating the effects of a new observation unit and a busy mid-level provider (MLP) service (both “non-teaching”) on the types of inpatients cared for by residents and students. We hypothesize that the observation unit and MLP service dramatically reduce the number of “bread and butter” medicine cases residents and students see, a finding that would have major implications for designing the ideal educational curriculum. In addition, we are implementing a new inpatient curriculum designed 1) to distribute patients more randomly between resident and MLP teams and 2) to create a supervisory relationship between senior residents and MLPs that might help prepare residency graduates to supervise MLP after residency. We then plan to assess the whether these curricular changes are successful in achieving these stated aims.
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