pain management and patient satisfaction in emergency department

BACKGROUND: Health reforms in service improvement have included the use of nurse practitioners. In rural emergency departments, nurse practitioners work to the full scope of their expanded role across all patient acuities including those presenting with undifferentiated chest pain. Currently, there is a paucity of evidence regarding the effectiveness of emergency nurse practitioner service in rural emergency departments. Inquiry into the safety and quality of the service, particularly regarding the management of complex conditions is a priority to ensure that this service improvement model meets health care needs of rural communities...

STUDY OBJECTIVE: We assess the effectiveness of patient-controlled analgesia in the emergency department (ED). We hypothesized that decline in pain intensity from 30 to 120 minutes after initial intravenous opioid administration is greater in patients receiving morphine by patient-controlled analgesia compared with usual care and would differ by a clinically significant amount. METHOD: This was a pragmatic randomized controlled trial of patient-controlled analgesia and usual care (opioid and dose at physician's discretion) in 4 EDs...

Objective The aim of this study was to compare emergency department (ED) key performance indicators for patients presenting with low back pain and seen by an advanced musculoskeletal physiotherapist (AMP) with those seen by other non-AMP clinicians (ED doctors and nurse practitioners).Methods A retrospective audit (October 2012-September 2013) was performed of data from three metropolitan public hospital EDs to compare patients with low back pain seen by AMP and non-AMP clinicians. Outcome measures included ED length of stay, ED wait time, admission rates and re-presentation to the ED...

Chronic low back pain (CLBP) is a primary care condition that overflows into the emergency department (ED). No ED-specific practice guideline exists for the management of patients with CLBP in the ED setting. Back pain is a common chief complaint, with cases of CLBP making up to 50% of the patients seen with back pain in an urban, freestanding ED affiliated with a multicampus health system in the Midwest where 25% of patients live below the poverty line and 21.8% do not have primary care. Kolcaba's Theory of Comfort guides the implementation of an evidence-based practice application project...

BACKGROUND: Guidelines recommend rapid, aggressive management of vaso-occlusive crisis (VOC) for patients with sickle cell disease (SCD). A large prospective research and quality improvement (QI) project was conducted to measure changes in clinical outcomes in two EDs-academic medical centers with emergency medicine residency programs and Level 1 trauma centers-during a 2.5-year time period (October 2011-March 2014). METHODS: A QI team used a Plan-Do-Study-Act approach to modify and implement changes to opioid analgesic protocols for the emergency department (ED) treatment of VOC...

INTRODUCTION: Pain is the most common complaint of patients referring to emergency department (ED). Considering the importance of pain management in ED, this study aimed to investigate the efficacy and feasibility of ultrasound-guided nerve blocks in this setting. METHODS: 46 patients who came to the ED with injured extremities were enrolled in the study and received either femoral, axillary or sciatic nerve block depending on their site of injury (1.5 mg Bupivacaine per kg of patient's weight)...

BACKGROUND: Pain is one of the most common reasons for emergency department (ED) visits in the United States. Ketamine is a sedative with N-methyl-D-aspartate (NMDA) receptor antagonism. Recent literature has suggested that the use of subdissociative dose ketamine (SDDK) may be safe and effective for acute pain. OBJECTIVE: The objective of our study was to evaluate ketamine in subdissociative doses as an adjunct for acute pain in the ED. METHODS: This was a single-center, prospective, randomized, double-blind, placebo-controlled trial that evaluated the use of SDDK in adult patients who presented to the ED with acute pain...

BACKGROUND: Immediate laparoscopic cholecystectomy is the accepted standard for the treatment of acute cholecystitis. The aim of the present study was to evaluate the feasibility of a standardized approach with tailored care maps for pre- and postoperative care by comparing pain, nausea and patient satisfaction after elective and emergent laparoscopic cholecystectomy. METHODS: From January 2014 until April 2015, data on pain and nausea management were prospectively recorded for all elective and emergency procedures in the department of visceral surgery...

OBJECTIVE: This prospective clinical trial was performed to compare the safety and efficiency of intra-articular lidocaine (IAL) versus intravenous sedative and analgesic (IVSA) in reduction of anterior shoulder dislocation. MATERIALS AND METHODS: Patients with anterior shoulder dislocation were randomly divided into 2 groups to receive IAL and IVSA. One group patients received an intravenous dose of 0.05 mg/kg midazolam and 1 μg/kg fentanyl, while the other group received 20 mL intra-articular lidocaine (1%)...

Health care delivery expectations that may affect patient and caregiver satisfaction are not clearly understood. This study examined caregiver expectations and satisfaction with urgent care in a pediatric emergency department. Of 201 caregivers surveyed, we found that caregivers have specific expectations regarding clinical care of their child in terms of radiographic imaging, blood testing, antibiotics, pain management, and subspecialty consultation. Caregivers were generally less dissatisfied with the actual care provided than the urgent care physicians expected...

Patients and practitioners rate the insertion of a nasogastric tube as one of the most painful and distressing procedures performed. Research supports using lidocaine and a nasal vasoconstrictor to significantly decrease patient discomfort. The recommended medications were not being used routinely in a large urban emergency department. METHODS: We identified departmental barriers using a nurse survey and physician interviews. We educated the nursing and physician staff about the comfort medications for nasogastric tube insertion recommended in the literature...

OBJECTIVE: The Institute of Medicine identified emergency department (ED) crowding as a critical threat to patient safety. We assess the association between changes in publicly reported ED length of stay (LOS) and changes in quality-of-care measures in a national cohort of hospitals. METHODS: Longitudinal analysis of 2012 and 2013 data from the American Hospital Association (AHA) Survey, Center for Medicare and Medicaid Services (CMS) Cost Reports, and CMS Hospital Compare...

Case managers are in a good position to recognize patients who have serious medical problems that are causing them and their family members stress, and refer them for a palliative care consultation, experts say. The palliative care team coordinates with the team providing medical care and helps control pain and other physical symptoms, relieves depression and anxiety, and provides support and spiritual help for the patient and family. The core palliative care team typically includes a medical specialist, a nurse who also acts as a case manager, a social worker, and a spiritual counselor...

OBJECTIVE: The purpose of this study was to elicit the opinions of Emergency Department (ED) physicians, currently practicing in the United States, regarding the impact of economic and regulatory factors on their management of patients exhibiting "drug seeking" behavior. METHODS: A descriptive, cross-sectional study, utilizing a convenience sample of ED physicians located in Florida and Georgia was conducted for a period of 2 months. The inclusion criteria specified that any ED physician, currently practicing within the United States, could participate...

To identify predictors of patient satisfaction with pain control measured after emergency department (ED) discharge. This was a prospective, cross-sectional study conducted in an academic, urban ED in the United States. Adult patients with a pain-related complaint were interviewed via telephone within 72 hr of discharge from the ED. A standardized questionnaire was used to obtain demographic and clinical information. The primary outcome of interest was patient satisfaction with pain management in the ED measured using the following question: "How often was your pain well controlled in the ED?" (0-10 scale; 0 = never, 10 = always)...

INTRODUCTION: To compare the cost-effectiveness and patient impact between acute magnetic resonance imaging (MRI) management and conventional management in the diagnosis of occult scaphoid fractures in a rural setting. METHODS: Consecutive patients presenting to a rural emergency department (ED) with a suspected scaphoid fracture were randomly assigned to either conventional management (6) or acute MRI management (10) (3 patients were excluded from the study analysis)...

PROBLEM: The aging population and the growing number of home hospice patients have resulted in increased utilization of emergency departments. This situation poses a clinical challenge to the ED staff in determining when lifesaving treatment is indicated and when end of life care begins. METHODS: Through a shared governance model, ED physicians and nursing staff aimed to implement a best practice model for the care of dying patients. An ED interdisciplinary team identified gaps and brainstormed methods to improve palliative measures and comprehensive care for actively dying patients...

BACKGROUND: Pain management and patient satisfaction were targeted in the emergency department of a Paris university hospital. In 1999, 77.0% of patients complained of pain on arrival and more than half of patients did not experience pain relief at discharge. The purpose of the study was to evaluate the outcomes of the implementation of a team piloting pain management on pain reduction and pain care satisfaction. METHOD: Two cross-sectional surveys (04/10/1999 to 19/10/1999 and 03/04/2007 to 18/04/2007) were conducted before and after a team piloting pain management was deployed in the emergency department...

BACKGROUND: Postoperative pain control in bariatric surgery is challenging, despite use of intravenous (IV) narcotics. IV acetaminophen is one pain control alternative. OBJECTIVE: The aim of this study was to investigate the economic impact of IV acetaminophen in bariatric surgery and its effect on patients' pain, satisfaction, and hospital length of stay. METHODS: In a randomized controlled trial, Group 1 (treatment) received IV acetaminophen plus IV narcotics 30 min before surgery, then medication plus IV narcotics/PO narcotics for the remaining 18 h...

Ambulatory care is an underdeveloped concept in the setting of emergency surgery, however it is recognised that many institutions will need to develop this service to cope with increased time and financial pressures.[1] There is increased emphasis on ambulatory care pathways for a variety of medical conditions.[2] Risk management is important in managing patients with acute abdominal pain in an outpatient setting and senior doctor support is essential. While the patient remains in the community, effective communication with the patient's primary care provider improves patient safety and satisfaction...