Implementing Evidence-Based Changes in Emergency Department Treatment: Alternative Vitamin Therapy for Alcohol-Related Illnesses

Study objective: We sought to test the effectiveness of an intervention designed to replace multivitamin infusions with alternative vitamin therapies when treating emergency department (ED) patients who present with alcohol-related illnesses. Most patients presenting to the ED with alcohol-related illnesses are not vitamin deficient, and thus the routine use of multivitamin infusions may be unnecessary. Methods: We created an educational document that included background literature, the costs of administering multivitamin infusions, and recommended alternative vitamin therapies. We then educated each emergency physician and changed the default electronic physician order entry in EPIC to an alternative vitamin treatment. Results: There were no differences in monthly alcohol-related ED visits between the preintervention (June 2008 to May 2009; mean 204; SD 17) and postintervention (June 2009 to May 2010; mean 217; SD 20) periods. A mean of 32 (SD 3.6) multivitamin infusions was administered each month preintervention; the postintervention mean was 1.1 (SD 2.7) multivitamin infusions per month. The difference was 31 multivitamin infusions per month (95% confidence interval 28 to 34 infusions). The overall percentage of patients receiving vitamin therapy after the intervention was approximately half that of those receiving multivitamin infusions before, 6.8% (SD 2.4%) versus 16% (SD 2.0%), difference 8.7% (95% confidence interval 6.8% to 11%). Conclusion: Our educational and order entry intervention was effective in changing physician vitamin prescribing behavior in ED patients with an alcohol-related illness. [Ann Emerg Med. 2012;59:408-412.]