Is adequate pain relief and time to analgesia associated with emergency department length of stay? A retrospective study

Abstract

ObjectivesEvaluate the association of adequate analgesia and time to analgesia with emergency department (ED) length of stay (LOS).Setting and DesignPost hoc analysis of real-time archived data.ParticipantsWe included all consecutive ED patients ≥18 years with pain intensity >6 (verbal numerical scale from 0 to 10), assigned to an ED bed, and whose pain was re-evaluated less than 1 h after receiving analgesic treatment.Outcome measuresThe main outcome was ED-LOS in patients who had adequate pain relief (AR=↓50% pain intensity) compared with those who did not have such relief (NR).ResultsA total of 2033 patients (mean age 49.5 years; 51% men) met our inclusion criteria; 58.3% were discharged, and 41.7% were admitted. Among patients discharged or admitted, there was no significant difference in ED-LOS between those with AR (median (25th–75th centile): 9.6 h (6.3–14.8) and 18.2 h (11.6–25.7), respectively) and NR (median (25th–75th centile): 9.6 h (6.6–16.0) and 17.4 h (11.3–26.5), respectively). After controlling for confounding factors, rapid time to analgesia (not AR) was associated with shorter ED-LOS of discharged and admitted patients (p<0.001 and <0.05, respectively). When adjusting for confounding variables, ED-LOS is shortened by 2 h (95% CI 1.1 to 2.8) when delay to receive analgesic is <90 min compared with >90 min for discharged and by 2.3 h (95% CI 0.17 to 4.4) for admitted patients.ConclusionsIn our study, AR was not linked with short ED-LOS. However, rapid administration of analgesia was associated with short ED-LOS.

A Multicenter Evaluation of the Impact of Sex on Abdominal and Fracture Pain Care

“…For the remaining patients, all pain care processes, medication administration times, and pain scores within the first 90 minutes, 180 minutes, 270 minutes and 360 minutes from triage were manually filtered and compiled together for further analysis. Analgesic administration in the first 90 minutes has been used as a threshold for evaluation of difference in pain care processes in prior studies 20 , because the literature suggests that up to an one-hour threshold is a permissible delay in managing severe pain 27, 28 and because 90 minutes is the median time to analgesics reported in many EDs. 29, 30 Sensitivity analyses were conducted using 90-minute intervals up to 360 minutes.…”

“…Additionally, few studies have examined disparities in the quality of pain treatment in the early hours of the ED visit. Time to pain treatment is an important metric as early analgesia administration has been shown to have an impact ED outcomes such as length of stay 20 and early pain relief, 21 may improve diagnostic accuracy 21 , and may prevent development of chronic pain. 22–24 To our knowledge, no multicenter study has examined gender-based disparities in early acute pain care process metrics, and how these early treatment disparities may affect patient pain outcomes.…”

Efficacy and safety of nebulized morphine given at 2 different doses compared to IV titrated morphine in trauma pain

“…Its control remains a challenge and health priority worldwide [1]. Several international recommendations [2,3] have been developed to optimize analgesic treatment in particular in busy and crowded care settings like the ED [4][5][6]. However, poor quality of care in patients with severe pain is frequent, and there are still barriers to prescribing opioids in the ED [7,8].…”

Cost‐effectiveness of the Collaborative Care to Preserve Performance in Cancer (COPE) trial tele‐rehabilitation interventions for patients with advanced cancers

“…Given the mounting concern over cancer costs, surprisingly, limited attention has been directed to potentially remediable drivers of patients’ requirement for health‐care services, namely pain and disablement. Associations between patients’ pain and their hospital and emergency department usage have been long recognized, particularly among cancer cohorts . However, linkages between patients’ functional status and their health‐care consumption, though robust, have received less attention.…”