OBJECTIVE: To investigate the potential impact of implementing alternatives to opioids (ALTOs) protocol in a community emergency department (ED) in North Texas. We hypothesize that the ALTO protocol is associated with decreased opioid utilization without affecting patient satisfaction to pain control and ED flow. DESIGN: A retrospective, single-center, cohort study. SETTING: An urban ED. PARTICIPANTS: Adult patients (age >
18 years old) who received pain medications in ED during the study timeframe were included. A total of 34,251 patients were included for final analysis. INTERVENTION: Patients receiving pain medication after the implementation of the ALTO protocol during March to August 2019 and patients during the same period from the prior year were identified as the post-protocol group and preprotocol group, respectively. MAIN OUTCOME MEASURES: The primary outcome was the change in ED opioid administration. Secondary outcomes included patient satisfaction to pain control, left without being seen (LWOBS), door-to-doctor time, and turnaround time. RESULTS: The total opioid administration rate decreased by 59.6 percent after the implementation of the ALTO protocol. The percentage of patients that LWOBS (p = 0.003) and the average door-to-doctor time (p <
0.001) were significantly decreased in the post-protocol group. There was no significant difference in patient satisfaction to pain control (p = 0.192) and average turnaround time (p = 0.209). CONCLUSIONS: Implementation of an ALTO protocol was associated with a significant reduction of opioid administration without a negative impact on patient satisfaction regarding pain control and ED flow.