Analgesia in the emergency department: why is it not administered?

2018 ◽  
pp. emermed-2018-207629
Author(s):  
Joyce Kant ◽  
Mahesha Dombagolla ◽  
Fiona Lai ◽  
Andreas Hendarto ◽  
David McDonald Taylor
Keyword(s):  
Emergency Department ◽  
Patient Satisfaction ◽  
Pain Management ◽  
Side Effects ◽  
Prospective Observational Study ◽  
Primary Outcome ◽  
Tertiary Referral ◽  
Convenience Sample ◽  
Patient Refusal

ObjectivePain management in the ED is often suboptimal, with many patients not receiving analgesia. We aimed to determine why some patients refuse it, why others do not receive it, and whether these variables impact on patient satisfaction with their pain management.MethodsWe undertook a prospective, observational study in a large, Australian, tertiary referral ED (February–May 2017). A convenience sample of consecutive adult patients with a triage pain score of ≥4 were examined. Data were collected from the medical record and the treating nurses. At follow-up at least 48 hours postdischarge, patients were asked if they received analgesia in the ED (if not, then why not) and how satisfied they were with their pain management (very dissatisfied/dissatisfied/slightly dissatisfied/slightly satisfied/satisfied/very satisfied). The primary outcome was why patients refuse analgesia.ResultsOf the 651 enrolled patients, 171 (26.3%) did not receive analgesia; for 30 (17.5%), patients and their nurses agreed that analgesia was refused. Patients mainly refused analgesia because their pain was not bad enough, they had recent analgesia intake, and concerns about side effects and interactions. Patients who received analgesia were more likely to be ‘very satisfied’ with their pain management (difference in proportions 10.8%, 95% CI 2.1 to 19.4). The satisfaction of patients who refused analgesia and those who did not receive analgesia for other reasons did not differ.ConclusionPatient refusal is the most common reason for patients not receiving analgesia. Analgesia receipt is associated with greater patient satisfaction. However, a patient’s knowledge of their analgesia receipt status may be incorrect. Disregard of the reasons for patients not receiving analgesia may underestimate the number offered analgesia.

scholarly journals A Comparison of Patient Satisfaction with Emergency Department Opt-In and Opt-Out Rapid HIV Screening

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Douglas A. E. White ◽  
Alicia N. Scribner ◽  
Maria E. Martin ◽  
Stacy Tsai
Keyword(s):  
Emergency Department ◽  
Patient Satisfaction ◽  
Primary Outcome ◽  
Emergency Department Patient ◽  
Hiv Screening ◽  
Convenience Sample ◽  
Study Objective ◽  
Opt Out ◽  
Race Ethnicity ◽  
Test Result

Study objective. To compare patient satisfaction with emergency department (ED) opt-in and opt-out HIV screening.Methods. We conducted a survey in an urban ED that provided rapid HIV screening using opt-in (February 1, 2007–July 31, 2007) and opt-out (August 1, 2007–January 31, 2008) approaches. We surveyed a convenience sample of patients that completed screening in each phase. The primary outcome was patient satisfaction with HIV screening.Results. There were 207 and 188 completed surveys during the opt-in and opt-out phases, respectively. The majority of patients were satisfied with both opt-in screening (95%, 95% confidence interval [CI] = 92–98) and opt-out screening (94%, 95% CI = 89–97). Satisfaction ratings were similar between opt-in and opt-out phases even after adjusting for age, gender, race/ethnicity, and test result (adjusted odds ratio 1.3, 95% CI = 0.5–3.1).Conclusions. Emergency department patient satisfaction with opt-in and opt-out HIV screening is similarly high.

scholarly journals Adherence to emergency department discharge prescriptions

CJEM ◽  
2009 ◽  
Vol 11 (02) ◽  
pp. 131-138 ◽  
Author(s):  
Corinne M. Hohl ◽  
Riyad B. Abu-Laban ◽  
Jeffrey R. Brubacher ◽  
Peter J. Zed ◽  
Boris Sobolev ◽  
...  
Keyword(s):  
Emergency Department ◽  
Health Services ◽  
Prospective Observational Study ◽  
Tertiary Care ◽  
Related Event ◽  
Convenience Sample ◽  
Emergency Department Discharge ◽  
Lower Odds Ratio ◽  
Use Of Health Services

ABSTRACTObjective:Nonadherence to prescribed medication is associated with increased morbidity and mortality as well as the increased use of health services. The main objective of our study was to assess the incidence of prescription-filling and medication adherence in patients discharged from the emergency department (ED).Methods:This was a prospective, observational study carried out at a Canadian tertiary care ED with an annual census of 69 000. We enrolled a convenience sample of patients being discharged with a prescription. We queried a provincial prescription-dispensing database 2 weeks later to determine whether prescriptions had been filled. We used a standardized follow-up interview to assess adherence and whether or not the patient experienced an adverse drug-related event (ADRE) or an unplanned revisit to an ED or clinic.Results:Of the 301 patients who agreed to participate, follow-up was successful for 258 (85.7%). Fifty-one patients (19.8%, 95% confidence interval [CI] 15.4%–25.1%) failed to fill their discharge prescriptions and 104 (40.3%, 95% CI 34.5%–46.4%) did not adhere to 1 or more medications. Antibiotics were associated with a lower odds ratio (OR) of nonadherence (OR 0.21, 95% CI 0.08–0.52). There was a trend toward increasing nonadherence in patients who reported an ADRE (OR 1.84, 95% CI 0.98–3.48) or had 2 or more medications coprescribed (OR 1.71, 95% CI 0.95–3.09). There was also a trend toward a higher risk of a revisit to an ED or clinic in nonadherent patients (OR 1.75, 95% CI 0.94–3.25).Conclusion:Approximately 4 in 10 patients discharged from the ED did not adhere to his or her prescribed medication. Our results suggest that patients who are prescribed antibiotics are more likely to be adherent, and that further evaluation of the associations between nonadherence, ADREs, the coprescription of 2 or more medications and the use of health services is warranted.

scholarly journals The Effect of Bedside Presentations in the Emergency Department on Patient Satisfaction

2011 ◽  
Vol 3 (4) ◽  
pp. 481-486 ◽  
Author(s):  
Craig I. Schranz ◽  
Robert J. Sobehart ◽  
Kiva Fallgatter ◽  
Robert H. Riffenburgh ◽  
Michael J. Matteucci
Keyword(s):  
Emergency Department ◽  
Patient Satisfaction ◽  
Resident Education ◽  
Statistical Significance ◽  
Future Research ◽  
First Year ◽  
Convenience Sample ◽  
Visual Analog Scales ◽  
Significant Difference ◽  
The Difference

Abstract Background Due to increasing time constraints, the use of bedside presentations in resident education has declined. We examined whether patient satisfaction in the emergency department is affected when first-year residents present at the bedside with attendings. Methods We performed an observational, prospective, nonblinded study in the emergency department of a military teaching hospital. We alternately assigned first-year residents to present a convenience sample of 248 patients to the attending physician at the patient's bedside or away from the patient. We measured patient satisfaction by using the Patient Satisfaction Questionaire-18 (PSQ-18), a validated survey instrument that utilizes a Likert scale, and additional nonvalidated survey questions involving Likert and visual analog scales. Results While the median PSQ-18 score of 74 (95% confidence interval [CI], 72–76) was higher for patient satisfaction when residents made bedside presentations than that for standard presentations, 72 (95% CI, 70–74), the difference did not reach statistical significance (P  =  .33). Conclusion There was no significant difference in overall patient satisfaction between residents' bedside presentations and presentations to attendings away from the patient. Although not significant, the differences noted in PSQ-18 subscales of communication, general satisfaction, and interpersonal manner warrant further investigation. Patients did not appear to be uncomfortable with having their care discussed and with having subsequent resident education at the bedside. Future research on patient satisfaction after implementation of standardized bedside teaching techniques may help further elucidate this relationship.

scholarly journals P092: Combatting sedentary lifestyles; can exercise prescriptions in the emergency department lead to a behavioural change in patients?

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S89-S89
Author(s):  
D. Lewis ◽  
K. Leech-Porter ◽  
F. Milne ◽  
J. Fraser ◽  
S. Hull ◽  
...  
Keyword(s):  
Emergency Department ◽  
Primary Outcome ◽  
Exercise Prescription ◽  
Behavioural Change ◽  
Significant Proportion ◽  
Intervention Group ◽  
Routine Care ◽  
Control Group ◽  
Post Hoc

Introduction: Patients with chronic diseases are known to benefit from exercise. Such patients often visit the emergency department (ED). There are few studies examining prescribing exercise in the ED. We wished to study if exercise prescription in the ED is feasible and effective. Methods: In this pilot prospective block randomized trial, patients in the control group received routine care, whereas the intervention group received a combined written and verbal prescription for moderate exercise (150 minutes/week). Both groups were followed up by phone at 2 months. The primary outcome was achieving 150 min of exercise per week. Secondary outcomes included change in exercise, and differences in reported median weekly exercise. Comparisons were made by Mann-Whitney and Fishers tests (GraphPad). Results: Follow-up was completed for 22 patients (11 Control; 11 Intervention). Baseline reported median (with IQR) weekly exercise was similar between groups; Control 0(0-0)min; Intervention 0(0-45)min. There was no difference between groups for the primary outcome of 150 min/week at 2 months (Control 3/11; Intervention 4/11, RR 1.33 (95%CI 0.38-4.6;p=1.0). There was a significant increase in median exercise from baseline in both groups, but no difference between the groups (Control 75(10-225)min; Intervention 120(52.5-150)min;NS). 3 control patients actually received exercise prescription as part of routine care. A post-hoc comparison of patients receiving intervention vs. no intervention, revealed an increase in patients meeting the primary target of 150min/week (No intervention 0/8; Intervention 7/14, RR 2.0 (95%CI 1.2-3.4);p=0.023). Conclusion: Recruitment was feasible, however our study was underpowered to quantify an estimated effect size. As a significant proportion of the control group received the intervention (as part of standard care), any potential measurable effect was diluted. The improvement seen in patients receiving intervention and the increase in reported exercise in both groups (possible Hawthorne effect) suggests that exercise prescription for ED patients may be beneficial.

Impact of Traditional Versus Flavored Tongue Depressors on Pediatric Oropharynx Exam

2017 ◽  
Vol 57 (9) ◽  
pp. 1053-1057
Author(s):  
Brian Murray ◽  
Marina Gore ◽  
Nicole R. Leonard ◽  
Nadia M. Pearson ◽  
Jeremiah J. Johnson ◽  
...  
Keyword(s):  
Emergency Department ◽  
Confidence Interval ◽  
Primary Outcome ◽  
Pediatric Patients ◽  
Convenience Sample ◽  
Provider Perceptions ◽  
Patient Discomfort ◽  
Tongue Depressor ◽  
Patient Reported ◽  
Secondary Outcomes

We compared patient-reported discomfort associated with oropharynx examination using traditional (unflavored) versus flavored tongue depressors among pediatric patients presenting to the emergency department in a single-blinded, placebo-controlled randomized trial using a convenience sample ages 3 to 12 years. Our primary outcome was patient discomfort. Secondary outcomes included provider perceptions of patient discomfort, provider-reported examination ease, and caregiver perceptions of patient discomfort. Of 96 recruited patients, 92 (95.8%) completed the study. Forty-six (50%) were randomized to a traditional tongue depressor. Mean patient-reported oropharynx examination discomfort scores were 2.3 cm (95% confidence interval = 1.4-3.2 cm) with traditional tongue depressors versus 1.9 cm (95% confidence interval = 1.0-2.8 cm) with flavored tongue depressors ( P = .72). There were similarly no significant differences between the 2 arms with regard to any of the secondary outcomes. We conclude that the use of flavored tongue depressors does not appear to significantly alleviate discomfort associated with examination of the oropharynx in pediatric patients.

scholarly journals P080: Clinical lead nurse practitioner Strathcona Community Hospital

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S85-S85
Author(s):  
D. K. Klemmer ◽  
C. Ziebel ◽  
N. Sharif ◽  
S. Grubb ◽  
S. Sookram
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Patient Satisfaction ◽  
Service Delivery ◽  
Nurse Practitioner ◽  
Community Hospital ◽  
Clinical Care ◽  
Family Physicians ◽  
Lost To Follow Up

Introduction: Prior to opening Strathcona Community Hospital (STCH) site leadership were tasked to develop an innovative care model. The central aim was quality improvement and patient safety optimization in the emergency department (ED) utilizing a nurse practitioner (NP) model. They developed 3 pillars: collaboration, multidisciplinary approach, and integration with the plan of improving patient satisfaction and ensuring no patient gets lost to follow up. NPs work in the STCH ED and the NP led Emergency Department Transition (EDT) Clinic in Ambulatory Care. In the ED NPs provide direct clinical care, judicious review of DI and microbiology reports, and care coordination for patients at risk of lost to follow up. The EDT clinic is an innovative NP lead clinic with the purpose of providing timely, high-quality follow up care for ED patients. Methods: Data for the service delivery indicators came from data repository and manual data collection looking at the following outcomes: timely review of DI/micro results; decreased ED visits for non-urgent/emergent issues; safe transitions in care and improved patient satisfaction. Quantitative data from service delivery, patient and surveys were analyzed using Microsoft Excel and SPSS 19. Results: From June 2016 to January 2017 ED NPs at STCH reviewed 3000 positive microbiology reports and made 517 f/u calls to those patients, and reviewed 3181 DI results. This has freed up approximately 2 hrs per day of ED physician time. When NPs were working in the ED, the number of patients who left without treatment (LWT) was approximately 50% less, and improved STCH ED wait times to be among the lowest in the Edmonton Zone. From June 2016 to January 2017, EDT NPs completed 837 patient visits; 371 letters to family physicians (FPs); 215 referrals; and connected 520 patients to a new FP. Patient satisfaction survey show 88-90% of the patients were satisfied with their care. Conclusion: NPs are integral members of the ED team at STCH, providing direct clinical care and several valuable follow up services for ED patients. The EDT clinic provides urgent follow up for ED patients unable to get a timely appointment with their FP or no access to primary care. The clinic also prevents unnecessary returns to ED, and aids to bridge ED services to family physicians or specialist. NPs are the common thread through all departments at STCH, contributing to quality improvement and high patient satisfaction.

scholarly journals Long-term Results of Hemiarthroplasty for Osteoarthritis of the First Metatarsophalangeal Joint

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Stefan Beekhuizen ◽  
Ron Onstenk
Keyword(s):  
Patient Satisfaction ◽  
Scale Score ◽  
Operative Treatment ◽  
Primary Outcome ◽  
Metatarsophalangeal Joint ◽  
Long Term Results ◽  
First Metatarsophalangeal Joint ◽  
Satisfaction Rates

Category: Big toe, MTP-1 joint osteoarthritis Introduction/Purpose: Osteoarthritis of the first metatarsophalangeal joint is the second most common disorder affecting the hallux. If non-operative treatment is not efficacious, operative treatment should be considered. Arthrodesis is considered standard care for grade III and IV osteoarthritis of the first metatarsophalangeal joint. If preservation of joint mobility is preferred, implant arthroplasty could be considered. Total arthroplasty is less recommendable because of high failure rates. However, recent studies showed similar short term results after arthrodesis and hemi joint replacement with greater satisfaction rates, as well as low postoperative pain, after hemiarthroplasty. In our study we mainly focussed on long-term subjective results like patient satisfaction as well as patient recommendation for the performed procedure including our primary outcome; the postoperative AOFAS HMI score. Methods: We therefore evaluated primary arthrodesis and hemiarthroplasty as treatment for arthritis of the first metatarsophalangeal joint. All 102 patients operated between January 2005 and December 2011 were asked to participate in our study, sixty-seven patients responded and were included. Forty-seven arthrodesis were performed in 40 patients using different fixation techniques and thirty-one hemiarthroplasties were performed in 27 patients using the BiopPro® First MPJ implant. Both procedures performed for stage 3 or 4 osteoarthritis and patients had been followed for at least five years, the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal Interphalangeal (AOFAS-HMI) scale score was measured as primary outcome. Secondary outcomes addressed satisfaction rates, recommendation of the performed procedure, number of unplanned surgical repeat procedures, return to daily activities (work as well as sports), and influence of smoking and diabetes mellitus on postoperative results. Finally, financial costs for both procedures were calculated. Results: The 47 primary arthrodeses and 31 hemiarthroplasties performed between January 2005 and December 2011 were evaluated. After a mean follow-up of 8.3 years (range 5-11.8) the mean AOFAS-HMI scale score after arthrodesis and after hemiarthroplasty were 72.8±14.5 and 89.7±6.6 respectively (p =.001). Patients were significantly more pleased after hemiarthroplasty (p<.001) and this procedure was better recommended (p<.001). The number of unplanned repeat surgical procedures did not differ between the two groups. No differences were found in postoperative work resumption, but patients returned to sports significantly sooner after hemiarthroplasty (p=.002). No association was found between smoking and the total AOFAS-HMI score. Overall costs, the sum of procedure costs as wel as additional costs, were quite similar for both procedures. Conclusion: Higher postoperative AOFAS HMI scores after a long-term follow-up (mean 8.3 years, range 5-11.8 years) were found after hemiarthroplasty compared to arthrodesis of the MTP-1 joint. Also greater patient satisfaction and better recommendation is seen after hemiarthroplasty. However return to work showed no differences, a significantly faster return to sports was seen after hemiarthoplasty. Based on these long-term results we could recommend hemiarthroplasty in future patient with osteoarthritis of the MTP-1 joint, with modest preference for the younger, more active patients.

scholarly journals Comparison of intravenous Acetaminophen and Morphine Sulfate for abdominal pain management in patients with acute abdomen

2019 ◽  
Vol 6 (5) ◽  
pp. 1626
Author(s):  
Mirsalim Seyedsadeghi ◽  
Jafar Ghobadi Samiyan ◽  
Keyvan Amini ◽  
Amir Ahmad Arabzadeh ◽  
Seyyed Mohammad Mosannen Tabatabaie ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Side Effects ◽  
Postoperative Pain ◽  
Acute Abdomen ◽  
Morphine Group ◽  
Rebound Tenderness ◽  
Intravenous Acetaminophen ◽  
Intravenous Morphine ◽  
The Mean

Background: Pain management is a crucial component in the postoperative care of patient. Opioids, which have been the mainstay of postoperative pain control for some time, are being used less because of significant adverse effects. Recently Intravenous acetaminophen that is an analgesic and antipyretic drug is used for reducing postoperative pain. Our Objective in this study was to use intravenous acetaminophen as an analgesic and antipyretic drug with the least complications and more safe than intravenous opioids for comparison with the effects of intravenous morphine sulfate in patients with acute abdominal surgery referred to emergency department of Fatemi Hospital.Methods: 120 patients with acute abdomen will be assigned into the study by randomized allocation. Demographic data, pain severity in admission to the emergency department and 30 minutes after injection, vital signs in admission, side effects, and clinical findings will record questionnaires. The pain level, tenderness and the rebound tenderness of the patients will determine by the Visual Analog scale. The subjects will be divided into two groups A and B randomly. The intravenous acetaminophen (15 mg/kg/100cc normal saline in the form of intravenous infusion for 30 minutes) will be administered for group (A) and intravenous morphine sulphate (0.1 mg/kg Slow-acting intravenous injection for 1.5 to 2 minutes) will be administered for group (B). After 30, 60 and 90 minutes, the patient's pain is re-examined. Changes in the patient's pain, tenderness, rebound tenderness and side effects will documented in two groups and they will be compared. Finally, the collected data will be analyzed.Results: The mean age of patients in acetaminophen group was 58.24±8.06 years with a mean age of 27-26 years and in morphine group was 56.7±7.63 years with age range of 34-69 years. There was no significant relationship between age and effect of intravenous acetaminophen and venous morphine sulphate (p=0.16). The mean of pain before injection of intravenous acetaminophen group was 8.92±1.25 and the mean pain before injection of morphine group was 8.80±1.35. There was no significant difference between the mean pain before injection of patients in the intravenous staphylococci group and the morphine group (p=0.049). The mean pain after injection of intravenous acetaminophen group was 4.46±1.25 and the mean pain after injection of the morphine group was 2.56±1.71. The mean pain after injection was significantly higher in patients with intravenous acetaminophen than in the morphine group (p<0.001).Conclusion: Due to the effectiveness of morphine in relieving the pain of patients, it is recommended that doctors and associates use this painkiller to relieve pain in patients.

Patient identification and tracking for chemotherapy delivery: Use of RFID or barcode technologies for automated self check-in.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 316-316
Author(s):  
Matthew C. Cheung ◽  
Maureen E. Trudeau ◽  
Ben De Mendonca ◽  
Kathy Beattie ◽  
Philomena Sousa ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Radio Frequency Identification ◽  
Primary Outcome ◽  
Patient Identification ◽  
Complex Processes ◽  
Frequency Identification ◽  
Check System ◽  
Continued Use ◽  
Motion Studies

316 Background: The Odette Cancer Centre (OCC) is the sixth largest cancer institution in North America and manages over 24,000 chemotherapy patient visits/year. We initiated an automated kiosk system whereby patients can “actively” self-check-in to the chemotherapy unit as part of a quality initiative to improve one of the most complex processes in patient care. Methods: From January-May 2012, consecutive patients receiving >2 cycles of chemotherapy were randomly assigned to either radio-frequency identification (RFID) or barcode technologies to facilitate self check-in and time-in-motion studies. In parallel, the former manual check-in system (with OCC staff) continued. The primary outcome was the proportion of patients with more 3 or more scheduled appointments who used the self-check system at least 2 times. Patient satisfaction was attained with baseline and post-study surveys. Results: The study accrued 81 patients (43 patients using RFID and 38 patients using barcodes). Mean age was 59 (20-81 years). Of 48 patients who completed baseline surveys, most had regular access to a computer (87.5%) and used the internet at least >1 hour/day (50%). However, 21% at baseline felt a person-to-person check-in was preferable to an automated option. With implementation of the study, 24 of 81 patients (29%) have used the kiosk only once. Of individuals with multiple scheduled appointments (at least 3), 50% assigned to the RFID group and 52.6% assigned to the barcode group used the kiosk at least 2 times (p=0.827; Fisher’s exact). In follow-up, 96.7% of patients agreed or strongly agreed that the kiosks were easy to use although only one-third (33.3%) of patients felt the new system improved the efficiency of care. Conclusions: An automated check-in process is feasible for a diverse population of patients receiving chemotherapy. Multiple uses of the kiosk technology suggest appropriate uptake and retention of the technology. Continued use of the system was not different between RFID and barcode technologies. Patient satisfaction was high despite the lack of improvement in efficiency. The next phase will incorporate patient tracking and real-time status updates to address these concerns.

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