Effect of Patient Volume and Acuity on Pain Management in the Emergency Department

The Social, Professional, and Legal Framework for the Problem of Pain Management in Emergency Medicine

“…At least one study, however, has indicated that staff-patient ratio (weighted by acuity of the patients' conditions) did not affect the proportion of patients who received pain medication. 30 As in other settings, institutional structure and procedures may also form barriers to effective pain relief in the ED. For example, ED procedures, typically requiring at least seven steps ("patient presentation and registration, nursing assessment and triage, placement in a treatment room, primary nurse assessment and documentation, physician evaluation, physician ordering of pain medication, nursing obtaining pain medication, and finally, ... nursing administration of pain medication") before the patient can receive any pain medication, create a formidable barrier to timely treatment and the avoidance of unnecessary ~uffering.3~ Several studies have documented lengthy delays in the first administration of pain medication to ED patients suffering serious trauma,32 and studies of patient's expectations indicate that these delays are probably a source of significant concern to patients.33 Pre-hospital emergency medical services have also been identified as a target for improvement of pain relief for the emergent ~atient.3~…”