Adequacy of pain assessment and pain relief and correlation of patient satisfaction in 68 ED fast-track patients.
BACKGROUND
The new standards of the joint commission on accreditation of healthcare organizations specify the patient's right to appropriate assessment and management of pain. With this impetus, we looked at our own practice to see how well we assess and manage patients with pain.


METHODS
Patients who presented with minor nonemergent pain were interviewed on arrival, and then again before discharge, with use of a structured questionnaire. A total of 68 completed pain surveys were analyzed.


RESULTS
With use of a visual analog scale, patients rated their pain on arrival and at discharge; they also rated pain they were willing to accept when it was time for discharge. Sixty percent of the patients went home with more pain than they were willing to accept. Fifty-one percent of the patients were offered something for pain, and only half of them said the pain relief was adequate. The median time from arrival to administration of pain medication was 104 minutes. Surprisingly, the median patient satisfaction rating for overall care was "very good."


CONCLUSIONS
This survey revealed that acute pain conditions are underevaluated and undertreated in one fast-track setting, suggesting that ED staff need more education about the management of acute pain. It also showed that relying on patient satisfaction surveys as surrogate markers for how well we manage pain is erroneous.
Blank
F S
FS
Baystate Medical Center, Springfield, MA, USA. del.blank@bhs.org
Mader
T J
TJ
Wolfe
J
J
Keyes
M
M
Kirschner
R
R
Provost
D
D
D000208:Acute Disease; D000328:Adult; D016529:Emergency Nursing / Q000592:standards; D004636:Emergency Service, Hospital / Q000592:standards*; D004638:Emergency Treatment / Q000379:methods / Q000592:standards*; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D015403:Nursing Evaluation Research; D010146:Pain / Q000175:diagnosis / Q000517:prevention & control* / Q000523:psychology*; D010147:Pain Measurement / Q000523:psychology* / Q000592:standards*; D017060:Patient Satisfaction; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires; D013997:Time Factors; D014218:Triage / Q000379:methods / Q000592:standards*