What is Known and Objective: Prescription drug stewardship is critical. Autopopulation(AP) of medication quantities may influence prescriber behaviour. We investigate the impact of AP removal(APR) on opioid prescribing. Methods: Inpatient and emergency department(ED) discharges with opioid pain medications 2 years before and after APR were identified. Milligrams of morphine equivalents(MMEs) prescribed were recorded. Group comparisons were performed using Mann-Whitney U tests. Spearman's rho was used to analyse correlations between pain level and quantity of prescribed opioids. Mann-Kendall tests assessed trends in prescription patterns. Generalized estimating equations assessed trends in total quantity of prescribed MME. Results and Discussion: A total of 53 608 patient encounters were included for analysis. In surgical patients, there were no trends in the frequency of prescriptions below, at or above the AP quantity pre-APR. Post-APR, there was a decrease in the percentage of prescriptions written for the AP quantity(τ = −.493, P = .001) and an increase in prescriptions for <30 tablets(τ = .468,P = .001). In non-operative patients, the pre-APR period was associated with a lower percentage of prescriptions >30 tablets and a greater percentage of prescriptions for <30 tablets. Interestingly, APR reversed this trend in prescriptions for >30 tablets and resulted in an increase in larger prescriptions. Multivariate analysis of the total prescribed quantity of MME found no significant trend across months for inpatients prior to and after APR (0.997, P = .065 and 1.003, P = .142; respectively). The ED model found a monthly downward trend in amount of prescribed MME prior to and after APR (0.986, P < .001 and 0.990, P < .001; respectively). In the inpatient setting, pain was positively correlated to discharge MME (ρ = .028, P < .001); with those reporting the highest pain receiving the greatest amount of opioids both pre-and post-APR. Interestingly, in the ED, this finding was negatively correlated (ρ = −.086, P < .001); with those reporting the lowest pain receiving the greatest amount of opioids both pre-and post-APR. What is New and Conclusions: AP removal may have unintended consequences, such as increased prescriptions for greater quantities. To drive down prescription amounts, lower anchor values may be of more utility than APR. The poor correlation of pain values with prescribed medications warrants further investigation.

The SP/AP area curve ratio significantly improves ECochG diagnostic sensitivity in possible MD. This ECochG refinement will allow earlier intervention to preserve inner ear function in MD.

No abstract

ECochG has long been shown to complement the diagnosis of MD, primarily through measurement of the SP/AP amplitude ratio. While reported in the literature to be highly specific to this disorder, ECochG's sensitivity in the general MD population remains relatively low (ranging from 20-65%). The current study assessed the sensitivity and specificity of the ECochG protocol we employ for suspected MD patients, which includes measuring both the amplitudes and areas of the SP and AP to clicks (to derive the SP/AP amplitude and area ratios), and the SP amplitudes to 1000 and 2000 Hz tone bursts. A retrospective chart review was conducted to compare ECochG results from 178 suspected MD patients with their eventual diagnoses. Measurements of highest sensitivity and specificity (determined using a logistic regression analysis) included: SP amplitude, SP area, SP/AP area ratio, and total SP-AP area. Sensitivity and specificity values associated with these measures were 92% and 84%, respectively. The sensitivity value is considerably higher than previously reported, and is attributable to the inclusion of area measurements in our protocol.

Objective Since their development in the 1970s electronic health records (EHRs) are now nearly ubiquitous. This study aims to characterize the daily interactions of otolaryngology providers with EHRs. Methods This study was a cross‐sectional review of provider efficiency profile (PEP) data, as collected by a major EHR vendor. Participating institutions had 6 months of de‐identified PEP data reviewed starting January 1, 2019. PEP data is generated for providers with scheduled patients, both attendings and advanced practice providers (APPs). Time metrics are recorded when a provider is interacting with the EHR including a 5‐second time‐out for inactivity. Results Data on 269 otolaryngologists and 29 APPs from 10 institutions were evaluated. On scheduled ambulatory clinic days attendings spent 70 ± 36 (mean ± standard deviation) min interacting in the EHR versus 108 ± 46 min for APPs. Of the daily EHR time, mean time in notes, clinical review, in basket, orders, and schedule were 30.1 ± 19.4, 9.6 ± 6.1, 7.3 ± 5.8, and 5.8 ± 7.6 min, respectively. Per patient visit, median (interquartile range) time in notes, clinical review, and orders were 3.19 (2.2–4.9), 1.14 (0.63–1.8), and 0.70 (0.47–1.05) min, respectively. Mean progress note length was 4638 ± 2143 characters. Conclusion Otolaryngology providers spend a meaningful portion of their clinic day interacting with the EHR. PEP data may provide means to target interventions and a metric to measure the impact of those interventions on provider EHR efficiency. Level of Evidence 3 Laryngoscope, 131:975–981, 2021