Moving toward patient‐centered care in the emergency department: Patient‐reported expectations, definitions of success, and importance of improvement in pain‐related outcomes

Abstract

Objectives: Musculoskeletal pain is a common emergency department (ED) presentation, and patient-centered care may improve quality of life, treatment satisfaction, and outcomes. Our objective was to investigate the expectations, definitions of success, and priorities of ED patients with musculoskeletal pain. Methods: We conducted a cross-sectional survey of the demographic, clinical, and psychosocial characteristics of adult ED patients (n = 210) with musculoskeletal pain. Patients completed the Patient-Centered Outcomes Questionnaire to quantify usual, desired, expected, and successful levels of pain and interference with daily activities, fatigue, and emotion from 0 (none) to 100 (worst imaginable). They also reported the importance of improvement in each domain. Cluster analysis identified subgroups by importance ratings. Patients were asked their willingness to try various pharmacologic and nonpharmacologic treatments. Fully completed surveys were analyzed (n = 174). Results: Most patients desired 100% resolution in each domain and defined treatment success as substantial (median = 63.2%-76.5%) reductions but expected only moderate (median = 45%-53.7%) improvements across all domains. Patients with previous pain episodes had similar desired levels but less stringent definitions of success and expectations for improvement. Cluster analysis identified three patient subgroups by importance ratings of each domain: (1) multiple domains important (n = 118) with high importance attached to all four domains, (2) pain and function important (n = 34) with high importance primarily for pain and interference with daily activities, and (3) only pain important (n = 22). Regardless of subgroup, there was a high willingness to use a variety of pharmacologic and nonpharmacologic treatments. Discussion: ED patients with musculoskeletal pain have expectations and goals that include addressing impairments in function, improving quality of life, and reducing pain.

Orthopaedic trauma patients’ experiences with emergency department care and follow-up through Virtual Fracture Care review: a qualitative study

“…These results are in accordance with current literature 9 14–17. Healthcare professionals can potentially reduce perceived waiting time in the ED by actively providing clarity about ED processes, expectations and addressing their concerns, and by timely providing analgesics 5 17–19. Furthermore, patients preferred clarity about their diagnosis and follow-up treatment plan as soon as possible.…”

An Adaptive Pragmatic Randomized Controlled Trial of Emergency Department Acupuncture for Acute Musculoskeletal Pain Management

“…We attained our feasibility goal with on average more than one subject enrolled per day and >95% of subjects in the ITT population completing the one-hour outcome. The study population consisted of broad demographic characteristics representative of the typical ED population seeking care for musculoskeletal pain, 3 and were similar across the AA+UC, PA+UC and UC arms ( Table 1 ). Enrolled subjects had a mean age of 46.1 years (16.5 SD, range: 19 – 85).…”

“…Treatment is particularly challenging in emergency department (ED) settings, where acute pain is typically severe, associated with emotional and psychological stressors, and compounded by diagnostic uncertainty. 3,4 Medications alone provide only a limited degree of pain relief, have potential side effects, and are limited in reducing chronic pain. [5][6][7][8] Moreover, significant disparities exist in the ED treatment of pain, resulting in worse pain outcomes for historically minoritized and underserved populations.…”

Willingness to use nonpharmacologic treatments for musculoskeletal pain in the emergency department: a cross-sectional study

“…This was an analysis of cross-sectional data on pain management expectations of patients presenting to an academic urban ED for undifferentiated musculoskeletal pain. 13 We collected patient-reported outcome (PRO) data from June 2018 to October 2019 on a convenience sample of adult patients in ED (18 years or older) with triage levels 3 to 5 who presented with a chief complaint of neck, back, or extremity pain deemed to be musculoskeletal (ie, not due to an alternative etiology such as infection, deep vein thrombosis, ischemia, and the like) by the treating ED provider (attending, resident, or physician assistant). Patients were excluded if they were non-English speaking or not able to consent.…”