title: Impact of a Chronic Pain Protocol on Emergency Department Utilization.
abstract: OBJECTIVE
  Patients suffering from chronic painful conditions frequently present to the emergency department (ED) for pain control. In an effort to better manage these patients we implemented and measured the effect of enrollment in a chronic pain protocol in a single ED.
  
  
  METHODS
  A retrospective (pre) and prospective (post) study design was utilized. We identified 46 frequent ED users suffering from chronic painful conditions. We then retrospectively documented their ED use and prescription controlled substance use for 6 months prior to enrollment in a chronic pain protocol and then 6 months postenrollment.
  
  
  RESULTS
  Preenrollment participating patients visited the ED on average 6.2 times in a 6-month period. Postenrollment their mean number of visits in the following 6 months decreased significantly to 2.2 times, or a 65% decrease (p < 0.001). Similarly, preenrollment, the patients were prescribed a median of 664 controlled substance pills in the entire state compared to 471 pills in the 6-month period postenrollment, or a 29% decrease (p < 0.022).
  
  
  CONCLUSIONS
  Through instituting a chronic pain protocol, we found significant reductions in the number of return visits to a single ED and the number of controlled substance medications prescribed by all providers. Additional studies using similar protocols could help establish their impact on the care of patients suffering from chronic pain and the potential to reduce healthcare costs, ED overcrowding, and prescription drug abuse.
authors.affiliation: Department of Emergency Medicine, Park Ridge, IL.
authors.forename: Jon C
authors.initials: JC
authors.lastname: Olsen
authors.affiliation: Advocate Lutheran General Hospital, Park Ridge, IL.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Ogarek
authors.affiliation: University of Illinois at Chicago, Chicago, IL.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Goldenberg
authors.affiliation: Russell Research Institute, Park Ridge, IL.
authors.forename: Suela
authors.initials: S
authors.lastname: Sulo
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D059350:Chronic Pain / Q000188:drug therapy* / Q000191:economics; D002985:Clinical Protocols; D004363:Drug Utilization; D004636:Emergency Service, Hospital / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000191:economics* / Q000379:methods*; D011446:Prospective Studies; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid