title: Pain care management in the emergency department: a retrospective study to examine one program's effectiveness.
abstract: BACKGROUND
  No clear consensus exists regarding the most appropriate approach to reducing repetitive ED visits for pain complaints. These visits create a burden on health care resources and may contribute to inappropriate and excessive use of opioid medications. The purpose of this study was to examine the pain management program in 1 emergency department (1) to determine whether ED visits significantly decreased among program enrollees; (2) to quantify program interventions applied to enrollees; and (3) to explore relationships between enrollee characteristics (sex, age, comorbidities, health coverage plans) and the program's interventions and outcomes.
  
  
  METHODS
  A retrospective, descriptive, correlational design was used to examine the medical records of 134 patients who were enrolled in a pain care management program during a 1-year period.
  
  
  RESULTS
  Study subjects' ED visits were reduced by 77%, from 3,689 total visits during the pre-enrollment year to 852 in the post-enrollment year (P < .001). As a result of the program, patients were referred to primary care providers (58%), addiction specialists (14%), dentists (4%), neurosurgeons (4%), and neurologists (4%). The most common pain management program interventions were narcotic restriction (65%), establishment of a non-narcotic treatment regimen (57%), and enactment of a "1 pharmacy/1 provider" restriction (23%).
  
  
  CONCLUSIONS
  This study supports existing evidence that patients with an excessive number of ED visits for pain-related complaints can be managed with a proactive pain care management program that includes coordination with a primary care provider and a supportive ED medical staff.
authors.affiliation: Emergency Department Case Manager, Kootenai Medical Center, Coeur d’Alene, ID 83814, USA.
authors.forename: Bat
authors.initials: B
authors.lastname: Masterson
authors.forename: Marian
authors.initials: M
authors.lastname: Wilson
mesh_terms: D000328:Adult; D000368:Aged; D016529:Emergency Nursing / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy / Q000451:nursing*; D059408:Pain Management; D016730:Program Development; D015397:Program Evaluation; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult