Original Contribution
Analgesia delivery in the ED

https://doi.org/10.1016/j.ajem.2006.05.004Get rights and content

Abstract

Objective

The aim of this study was to evaluate the effectiveness of analgesia delivery, in the emergency department setting, to patients presenting with acute pain, with regard to guidelines from the British Association of Accident and Emergency Medicine (BAEM).

Methods

A retrospective analysis of patient records. We measured the time intervals between patient arrival, assessment, and the delivery of analgesia. Clinical outcomes were compared with national target guidelines.

Results

The mean interval for patients with moderate pain was 3 hours and 46 minutes, and for those with severe pain, 1 hour and 12 minutes. The range was from 8 minutes to 4 hours and 11 minutes. The number of patients not receiving analgesia within BAEM best practice guidelines was 68%.

Conclusion

There is a significant delay in patients with acute pain receiving any form of analgesia. Performance in relation to BAEM guidelines is poor. Several areas have been identified to make practical changes to service provision and patient care.

Introduction

Pain is one of the most common reasons behind the presentation of individuals to hospital, and indeed, relieving the burden of human suffering is one of the major goals of the health service [1]. Do patients who attend emergency departments (EDs) with any form of acute pain receive pain relief in an efficient manner, or are people suffering unnecessarily for a prolonged period [2]? Previous studies have reported that pain is undertreated in the ED [3]. An attitude of suspicion, a culture of ignoring the problem, and an environment that is not conducive to change in practice combine to present formidable obstacles for effective pain management in the emergency setting [4].

Recent guidelines [5], [6] for the management of pain in the ED have been introduced by the British Association of Accident and Emergency Medicine (BAEM); they state that:

  • -

    Patients in severe pain (pain score, 7-10) should receive appropriate analgesia within 20 minutes of arrival or triage, whichever is the earliest.

  • -

    Patients with moderate pain (pain score, 4-6) should be offered analgesia at triage.

  • -

    Ninety percent of patients with severe pain should have documented evidence of reevaluation and action within 30 minutes of receiving the first dose of analgesic.

  • -

    Seventy-five percent of patients with moderate pain should have documented evidence of reevaluation and action within 60 minutes of receiving the first dose of analgesic.

In this clinical study, we sought to discover how effective we are in achieving these goals [7]. We describe our current performance and factors influencing the delays in treatment. We also evaluate the process of analgesia provision in the emergency setting.

Section snippets

Methods

This is a secondary analysis of prospectively collected data. All patients attending the accident and emergency (A&E) department of a busy hospital in East Sussex have a clerking card, which comprehensively records all the information on each patient encounter, from initial assessment and observations to the doctor's clerking and medication prescription and, specifically, a time record of each event relating to the patient's treatment. These written records are then scanned and stored for

Results

The study sample comprised 1821 patients who made a total number of 1887 visits to the ED in April and July 2004. Patients without any form of pain symptom or analgesia requirement were excluded from the study, as were those younger than 18 years. Of the 473 pain patients, there were 213 (45%) in severe pain and 105 (22%) in moderate pain. The breakdown of the different pain types into discrete groups is in Table 1, with attendances for musculoskeletal pains being the largest group, followed by

Discussion

Acute pain is one of the most common symptoms of patients attending EDs. In the United Kingdom, EDs see approximately 13 million people each year [2]; around 25% of those will be presenting with some form of acute pain symptom, and they need to be treated swiftly. The BAEM guidelines for analgesia delivery are unusual in the modern National Health Service because they are essentially a “care-based” treatment target, and indeed, management of acute pain is not just about fulfilling guidelines

Acknowledgments

The authors thank Mrs Val Loseby, Department of Clinical Audit, Conquest Hospital, Hastings, East Sussex, UK, and Dr Clare Ilsley who proofread the manuscript.

References (15)

  • D.E. Fosnocht et al.

    Changing attitudes about pain and pain control in emergency medicine

    Emerg Med Clin North Am

    (2005)
  • D.B. Diercks

    Door-to-ECG time in patients with chest pain presenting to the ED

    Am J Emerg Med

    (2006)
  • M.F. Nicol et al.

    “Why haven't you taken any pain killers?” A patient focused study of the walking wounded in an urban emergency department

    Emerg Med J

    (2003)
  • Meikle J.A&E leaves patients in pain too long. The Guardian. August 8, 2005....
  • J. Miner et al.

    Patient and physician perceptions as risk factors for oligoanalgesia: a prospective observational study of the relief of pain in the emergency department

    Acad Emerg Med

    (2006)
  • BAEM—Clinical Effectiveness Committee. Guidelines for the management of pain in adults, 2005. Available at...
  • Clinical Standards in A&E Departments. Clinical Effectiveness Committee. BAEM January 2002. Available at...
There are more references available in the full text version of this article.

Cited by (67)

  • Effect of triage nurse-led application of the ottawa ankle rules on pain and patient satisfaction with emergency department care

    2020, Clinical Epidemiology and Global Health
    Citation Excerpt :

    In addition, pain relief can improve patients' comfort and reduce their anxiety.17 Therefore, ED health care providers and the protocols or standing orders followed must consider continuous pain assessment and prompt pain management during patient's stay and discharge from the ED.18 There are no studies which have examined the effect of OAR on acute ankle pain that we could compare with.

  • A systematic review of the pain scales in adults: Which to use?

    2018, American Journal of Emergency Medicine
View all citing articles on Scopus
View full text