The Reality of Pain Scoring in the Emergency Department: Findings From a Multiple Case Study Design

Abstract

Background: At times of increasing pressure on emergency departments, and the need for research into different models of service delivery, little is known about how to recruit patients for qualitative research in emergency departments. We report from one study which aimed to collect evidence on patients' experiences of attending emergency departments with different models of general practitioners, but faced challenges in recruiting patients. This paper aims to identify and reflect on the challenges faced at all stages of patient recruitment, from identifying and inviting eligible patients, consenting them for participation and finally to engaging them in interviews and make recommendations based on our learning. Methods: A thematic analysis was carried out on field-notes taken during research visits and meeting minutes of discussions to review and improve patient recruitment throughout the study. Results: The following factors influenced the success of patient recruitment in the emergency department setting: complicated or time-consuming electronic health record systems for identifying patients; narrow participant eligibility criteria; limited research nurse support; and lack of face-to-face communication between researchers and eligible patients. Conclusions: This paper adds to the evidence for improving patient recruitment in different settings, with a focus on qualitative research in emergency departments. Our findings have implications for future studies attempting to recruit patients in similar settings.

How can pain management in the emergency department be improved? Findings from multiple case study analysis of pain management in three UK emergency departments

“…Attempts to measure pain management at an organisational (ED) level (ie, within audit or clinical guidelines) relied heavily on the use of the pain score, which staff did not perceive to be an appropriate objective measure with which to realistically measure pain management. This finding has been reported in further detail elsewhere 17. This limited capacity for accountability, weighed up against concerns around opioid seeking, or the safety implications of overprescribing resulted in a lack of consequences for the undertreatment of pain.…”

“…Monitoring outcomes and ensuring accountability may be key to enabling behaviour change, particularly if staff can legitimise outcome measures used. Outcome measures should avoid over-reliance on pain scores due to low perceived validity of the score, and variability in how scores are documented, but incorporate patient-focused measures such as ‘is your pain under control’ for staff to understand whether interventions are having a positive impact on patient experience 17. Audit and feedback have been demonstrated to be effective methods of enabling behaviour change in EDs,25 and the findings of this research indicate that audit and feedback were key tools in challenging embedded beliefs, enabling staff to understand and acknowledge poor current practice and the need for improvement.…”

Challenges of recruiting emergency department patients to a qualitative study: a thematic analysis of researchers’ experiences

“…Previous research has successfully used "informal interviewing" as a practical technique for gaining patient perspectives, in person, in busy emergency departments [15]. Implementation of the new Emergency Care Dataset (ECDS) in England, with the intent to extend into Ambulance and Integrated Urgent Care will ensure that in future there will be improved quantitative data to identify both presenting conditions and outcomes in patients who access Urgent and Emergency Care services.…”

Challenges of recruiting emergency department patients to a qualitative study: a thematic analysis of researchers’ experiences

“…Previous research has successfully used "informal interviewing" as a practical technique for gaining patient perspectives, in person, in busy emergency departments [15]. Informal interviewing involves informal conversations with participants to enable more open discussions than formal interviewing, making the process of gathering data on patient experience easier and faster than formal interviewing methods [15].…”