Decreasing Time to Pain Relief for Emergency Department Patients with Extremity Fractures

Abstract

Significant delays occur in providing adequate pain relief for patients who present to the emergency department (ED) with extremity fractures. The median time to pain medication administration for patients presenting to our ED with extremity fractures was 72.5 minutes. We used a multidisciplinary approach to implement three improvement cycles with the goal of reducing the median time to pain medication by 15% over an eight month time period. First, we redesigned nursing triage and treatment processes. Second, we improved nursing documentation standardization to ensure accurate tracking of patients who declined pain medication. Third, through consensus building within our physician group, we implemented a department-wide standard of care to provide early pain relief for extremity fractures. Median time to pain medication for patients with an extremity fracture reduced significantly between the pre-and post-intervention periods (p=0.009). The average monthly median time to medication was 72.5 minutes (95% CI: 57.1 to 88.0) before the intervention (Jan 2013-Oct 2014) and 49.8 minutes (95% CI: 42.7 to 56.9) after the intervention (November 2014 to June 2016). In other words, monthly median time was 31% faster (22.7 minute difference) in the post intervention period. Implementing three key interventions reduced the time to pain medication for patients with extremity injuries. Since June 2016 the reductions in median time to medication have continued to improve.

Pain management in the emergency department: results from an observational longitudinal prospective study in a second-level urban hospital

“…However, in the literature, we still find many variable data, with some studies stating an average time-to-analgesia of more than 70 minutes for traumas. 17 Results concerning level of satisfaction on medical and nursing care are quite excellent; however, almost half of enrolled patients have reported lack of information about pain management. This aspect leaves large space for progress, either by offering the patients specific folders on the matter, or urging, through explicit training, health care personnel to improve their communication skills the use of informative material or by education of the health care personnel to improve their communicative skills.…”

Burden of Pediatric Functional Gastrointestinal Disorder in an Emergency Department—A Single-Center Experience

“…This likely contributes to the poorer quality of life in families experiencing FAP and FC and places pressures on EDs attempting to manage large numbers of acute presentations within 4 hours of arrival. In comparison, pain intervention in fractures presenting to the ED only took an average of 49.8 minutes (after intervention was implemented), 17 with intervention being implemented faster than in FC and FAP symptoms for the same end outcome of discharge.…”

Improving Pain Management Knowledge Among Nurses

“…Over the years, the tool has been revised to reflect various changes associated with pain management practices [1]. According to Heilman, Tanski, Burns, Lin, and Ma, timeliness of pain relief is a part of the Institute of Medicine's (IOM) six aims to improve quality [23]. Therefore, improving pain assessment, management, and documentation will assist in meeting the goals/aims set forth by the IOM, thereby enhancing the patient experience.…”