ED triage pain protocol reduces time to receiving analgesics in patients with painful conditions.
BACKGROUND
Studies suggest that collaborative nursing protocols initiated in triage improve emergency department (ED) throughput and decrease time to treatment.


OBJECTIVE
The objective of the study is to determine if an ED triage pain protocol improves time to provision of analgesics.


METHODS
Retrospective data abstracted via electronic medical record of patients at a safety net facility with 67 000 annual adult visits. Patients older than 18 years who presented to the ED between March 1, 2011, and May 31, 2013, with 1 of 6 conditions were included: back pain, dental pain, extremity trauma, sore throat, ear pain, or pain from an abscess. A 3-month orientation to an ED nurse-initiated pain protocol began on March 1, 2012. Nurses administered oral analgesics per protocol, beginning with acetaminophen or ibuprofen and progressing to oxycodone. Preimplementation and postimplementation analyses examined differences in time to analgesics. Multivariable analysis modeled time to analgesics as a function of patient factors.


RESULTS
Over a 27-month period, 23 409 patients were included: 13 112 received pain medications and 10 297 did not. A total of 12 240 (52%) were male, 12 578 (54%) were African American, and 7953 (34%) were white, with a mean (SD) age of 39 years (13 years). The pain protocol was used in 1002 patients. There was a significant change in mean time (minutes) to provision of analgesics between preimplementation (238) and postimplementation (168) (P < .0001). Linear regression showed the protocol-delivered medications to younger patients and of lower acuity in a reduced time. Variables not related to time to provision of medication included sex, payer, and race.


CONCLUSIONS
Emergency department triage pain protocol decreased time to provision of pain medications and did so without respect to payer category, sex, or race.
Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE. Electronic address: aaron.barksdale@unmc.edu.
Aaron Nathan
AN
Barksdale
Department of Emergency Medicine, Truman Medical Center/UMKC School of Medicine, Kansas City, MO.
Jeff Lee
JL
Hackman
Department of Biomedical and Health Informatics, UMKC School of Medicine, Kansas City, MO.
Karen
K
Williams
Department of Emergency Medicine, Truman Medical Center/UMKC School of Medicine, Kansas City, MO.
Matt Christopher
MC
Gratton
D000038:Abscess / Q000150:complications; D000328:Adult; D000700:Analgesics / Q000627:therapeutic use*; D001416:Back Pain / Q000188:drug therapy; D002985:Clinical Protocols; D004433:Earache / Q000188:drug therapy; D004636:Emergency Service, Hospital / Q000592:standards; D005121:Extremities / Q000293:injuries; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D059408:Pain Management / Q000592:standards*; D010612:Pharyngitis / Q000188:drug therapy; D057184:Practice Patterns, Nurses'; D012189:Retrospective Studies; D061665:Time-to-Treatment; D014218:Triage / Q000379:methods*
D000700:Analgesics