Procedural pain management in a community emergency department: A pilot study of feasibility and efficacy

Abstract

Introduction: Pain is a common reason for presentation to the Emergency Department, and non-opioid therapies to relieve pain are desirable. Access to pain management programs may be limited in community hospitals without academic pain medicine training programs. Our objective was to investigate the feasibility of improving non-opioid pain management in a community hospital by providing interventional or procedural pain management in the Emergency Department setting, led by Emergency Physicians. Methods: This was a pilot study examining the efficacy of pain relief and financial feasibility of an Emergency Physician led procedural pain management program in a community hospital. Two physicians at our hospital were dedicated to pain management procedures in our ED over eight 8-hour ED shifts. Procedures performed included nerve blocks, trigger point injections, cervical injections, and osteopathic manipulation. Results: Our physicians treated 47 patients with a total of 57 procedures. Average pain score before pain management procedures in the ED was 8.8 out of 10, which decreased to 1.9 out of 10 after the procedure (p<0.001). 97.9 % of patients expressed satisfaction with the pain management procedure. Our physicians generated $314.81 in charges per procedure, and averaged 7.1 procedures per shift. Reimbursement for charges depends on payor mix. Conclusion: Our pilot project of an ED physician-led procedural pain management program was successful in reducing patients' pain, and patients were satisfied with their pain relief from the program. Financial sustainability depends on the volume of procedures done and the payor mix/reimbursement.