title: The national trend in quality of emergency department pain management for long bone fractures.
abstract: BACKGROUND
  Despite national attention, there is little evidence that the quality of emergency department (ED) pain management is improving.
  
  
  OBJECTIVE
  To compare the quality of ED pain management before and after implementation of the Joint Commission on the Accreditation of Healthcare Organizations' standards in 2001.
  
  
  METHODS
  The authors performed a retrospective cohort study by using the National Hospital Ambulatory Medical Care Survey from 1998-2003. Patients who presented to the ED with a long bone fracture (femur, humerus, tibia, fibula, radius, or ulna) were compared. The authors extracted data on patient, visit, and hospital characteristics. The primary outcomes were the proportion of patients who received assessment of pain severity and who received analgesic treatment.
  
  
  RESULTS
  There were 2,064 patients with a qualifying fracture in the study period, 834 from 1998-2000 and 1,230 from 2001-2003. Compared with the early period, a higher proportion of patients in the late period had their pain assessed (74% vs. 57%), received opiates (56% vs. 50%), and received any analgesic (76% vs. 56%). Patients in the late period had higher odds of receiving any analgesia (adjusted odds ratio [OR], 1.43) and opioid analgesia (adjusted OR, 1.27) compared with the early period. Patients in the middle age group (adjusted OR, 2.28) or those seen by physician assistants (adjusted OR, 2.05) were more likely, whereas those with Medicaid (adjusted OR, 0.58) and those in the Northeast were less likely, to receive opiates.
  
  
  CONCLUSIONS
  Although the quality of ED pain management for acute fractures appears to be improving, there is still room for further improvement.
authors.affiliation: Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Tamara S
authors.initials: TS
authors.lastname: Ritsema
authors.forename: Gabor D
authors.initials: GD
authors.lastname: Kelen
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pronovost
authors.forename: Julius Cuong
authors.initials: JC
authors.lastname: Pham
mesh_terms: D000328:Adult; D004636:Emergency Service, Hospital / Q000592:standards* / Q000639:trends; D005260:Female; D050723:Fractures, Bone / Q000150:complications*; D006801:Humans; D007591:Joint Commission on Accreditation of Healthcare Organizations; D008297:Male; D010146:Pain / Q000209:etiology; D059408:Pain Management; D010147:Pain Measurement; D011787:Quality of Health Care; D012189:Retrospective Studies; D014481:United States