Alternatives to Opiates (ALTO) Program Makes Big Gains

The national opioid crisis is ongoing and Covid hasn’t helped. As the DEM’s Director of Public Health, Jake Manteuffel MD, looked for a way to decrease our use of opioids in the ED and implemented the Alternatives to Opiates (ALTO) program. The program was started in November 2019 and 21 months of data has been analyzed. The initial goal was to reduce our opiate administration (measured in morphine milliequivalents [MME]) per patient encounter in emergency departments across the entire Henry Ford Health by 15% within 1 year compared to a 3 year prior baseline with the implementation of this project. Extreme ED circumstances and unprecedented ED boarding were significant confounders to the original data analysis, so the data presented excludes admitted patients.

At HFH Main Emergency Department, opiate administration has decreased by 15.3% in patients discharged from the Emergency Department after ALTO implementation when compared to baseline.
Across the entire Henry Ford Health system, opiate administration was decreased 9.5% in patients discharged from emergency departments.

Individual sites are as follows:

• HFH Main: 15.3% decrease
• HF Macomb: 13.4% decrease
• HF West Bloomfield: 0.5% increase
• HF Allegiance: 1.0% increase (baseline data only back to Aug 2017)***
• HF Wyandotte: 12.8% decrease
• HF Fairlane: 3.3% decrease
• HF Sterling Heights: 19.7% decrease
• HF Cottage: 29.0% decrease
• HF Brownstown: 5.9% decrease

***HF Allegiance joined us in Aug 2017 and therefore their data is skewed due to missing 10 months of prior data compared to other sites, in addition HF Allegiance has been ahead of the other sites in the use ALTO medications including sub-dissociative ketamine and lidocaine patches prior to formal ALTO implementation***

Future data analysis will examine ALTO medication usage. Subanalysis will examine opiate administration in MME for all patients indexed to the length of stay in hours.

Dr. Manteuffel encourages and challenges all care givers to decrease the use of opiates. “ Remember opiates are indicated for some patients with acute pain, however, I would encourage you to think ALTO first when considering a patient’s pain, “ notes Dr. Manteuffel. The ALTO medications are easily accessed through the ALTO quicklist in EPIC.

Contact Dr. Manteuffel for help getting ALTO started in your ER.