title: Timely pain management in the emergency department.
abstract: BACKGROUND
  Delivering timely pain relief remains a challenge for most emergency departments.
  
  
  OBJECTIVE
  To evaluate the effectiveness of a policy aimed at delivering analgesics within 30 min to patients presenting to an emergency department with severe pain.
  
  
  METHODS
  Subjects were aged ≥19 years, had a principal diagnosis of renal colic, hip fracture, or sickle cell disease, reported a pain score ≥8 on a scale of 0 to 10 at triage, and continued to report a score in this range until receiving analgesia. The study compared proportions of patients receiving analgesics within the 30-min target, median time to analgesic administration, and median time to relief of severe pain (decline in pain level to score <8) during 6 months before vs. 6 months after implementation of the new pain management policy.
  
  
  RESULTS
  Paradoxically, the median total waiting time to analgesic administration increased from 64 min (n = 75) to 80 min (n = 70) after policy implementation (p = 0.01), and the proportion of patients receiving analgesics within 30 min declined from 17% (13/75) to 7% (5/70) (p = 0.08). Median time to relief of severe pain did not differ significantly between periods (130.5 vs. 153 min; p = 0.31).
  
  
  CONCLUSIONS
  After implementation of the new pain management policy, the proportion of patients with severe pain receiving analgesics within 30 min actually declined. Although a 30-min target may be unrealistic, it seems reasonable to conclude that something is wrong when patients with notoriously painful conditions must typically wait 1-2 h to obtain relief. Given the millions of individuals who receive care in emergency departments nationwide each year, the suffering caused by delays occurs on a large scale, so creative approaches are clearly needed to overcome the obstacles.
authors.affiliation: Office of Health Outcomes Research, Winthrop University Hospital, Mineola, New York; School of Medicine, Stony Brook University, Stony Brook, New York.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Patrick
authors.affiliation: School of Medicine, Stony Brook University, Stony Brook, New York; Department of Emergency Medicine, Winthrop University Hospital, Mineola, New York.
authors.forename: Barry M
authors.initials: BM
authors.lastname: Rosenthal
authors.affiliation: Department of Health and Nutrition Sciences, Brooklyn College, Brooklyn, New York.
authors.forename: Carina A
authors.initials: CA
authors.lastname: Iezzi
authors.affiliation: Office of Health Outcomes Research, Winthrop University Hospital, Mineola, New York; School of Medicine, Stony Brook University, Stony Brook, New York.
authors.forename: Donald A
authors.initials: DA
authors.lastname: Brand
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use*; D000755:Anemia, Sickle Cell / Q000150:complications; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006620:Hip Fractures / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D016134:Organizational Policy; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D017410:Practice Guidelines as Topic; D056844:Renal Colic / Q000188:drug therapy; D061665:Time-to-Treatment / Q000592:standards* / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D000700:Analgesics
keywords: analgesics; emergency medicine; pain management