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SLV Emergency Departments Unite in ALTO ED Project

San Luis Valley's hospital emergency departments join together against the opioid epidemic. In a united effort, Conejos County Hospital (CCH), Rio Grande Hospital (RGH), and San Luis Valley Health’s Regional Medical Center (RMC) plan to curb prescribing opioids in the emergency room setting. The Colorado Hospital Association (CHA) developed an Alternative to Opioid (ALTO) plan and implemented a pilot program across the state with successful results. This plan includes resources, training and much more that has assisted the hospital staff to align their treatment and diagnosis and prescribing as much as possible.  “By combining our efforts across the SLV, it gives us confidence that patients will be treated the same regardless of which ED they are in.  The ALTO program doesn’t dictate that we can no longer prescribe opioids, but provides us with alternative plans to help patients who are in pain with medicine that might not be as addictive down the road,” commented Dr. Megan Koenig, Medical Director at SLVH’s RMC ED.

Dr. Ely Walker, Rio Grande Hospital

Dr. Ely Walker, Rio Grande Hospital

Dr. Ely Walker, RGH Physician, added to this statement, “The opioid epidemic has hit the San Luis Valley particularly hard with one of the highest death rates in the state.  Given that four out of five individuals with opioid use disorder become addicted first with prescription opioids, we are attempting to reduce initial exposures to opioids by treating pain with effective alternatives.  We certainly don’t want patients to be in pain, but opioids are not always the best first choice and the guidelines from the CHA project will provide us with more tools in our toolbox to tailor pain treatment to each individual.  We at Rio Grande Hospital are excited to partner with the other valley hospitals in this initiative.”


Dr. Donna Nelson, SLV Health Conejos County Hospital ED Director

Dr. Donna Nelson, SLV Health Conejos County Hospital ED Director

Dr. Donna Nelson, Medical Director for SLVH CCH’s ED adds, “It takes all of us working together. Patients need options.  We want to start the conversation with the patient in the emergency room when possible and help the individual by providing access to resources instead of just writing a prescription and then possibly never seeing that person again.”

                According to the CHA website, in 2017, CHA and its partners developed the Colorado Opioid Safety Pilot, a study that was conducted in 10 hospital emergency departments (EDs) over a six-month span with a goal of reducing the administration of opioids in those EDs by 15 percent. The cohort of 10 participating sites achieved an average 36 percent reduction in the administration of opioids during those six months, as well as a 31.4 percent increase in the administration of alternatives to opioids (ALTOs). Based on the success of the pilot, CHA has launched the Colorado ALTO Project to implement this program in all hospitals. Colorado is at the forefront of the nation’s opioid epidemic with the 12th highest rate of prescription opioid misuse and abuse out of all 50 states. Colorado hospitals, particularly the EDs, are in a strong position to integrate new and more effective pain management treatments that are tailored to each patient’s unique pain experience. This project employs new pain management guidelines, focusing on alternatives to opioids (ALTOs) as a first resort in treating painful conditions.

                “As emergency room providers, our goal is still to manage painful conditions for our ED patients and return them to a maximum quality of life while also recognizing and controlling the inherent risks of prescribing highly addictive medications like opioids,” stated Dr. Koenig.

- Radio Show- Listen to Dr. Megan Koenig and Monic Hinds Discuss ALTO