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pain management and patient satisfaction in emergency department

Fabian Grass, Matthieu Cachemaille, Catherine Blanc, Nicolas Fournier, Nermin Halkic, Nicolas Demartines, Martin Hübner
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...
December 1, 2016: BMC Surgery
Parvin Kashani, Fatemeh Asayesh Zarchi, Hamid Reza Hatamabadi, Abbas Afshar, Marzieh Amiri
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%)...
June 2016: Turkish Journal of Emergency Medicine
Greg P Marconi, Phung K Pham, Alan L Nager
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...
November 23, 2016: Journal of Ambulatory Care Management
Ranee Solomon, Karen Jurica
: 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...
October 20, 2016: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
Anna Marie Chang, Amber Lin, Rongwei Fu, K John McConnell, Benjamin Sun
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...
February 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
(no author information available yet)
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...
June 2016: Hospital Case Management: the Monthly Update on Hospital-based Care Planning and Critical Paths
Sharon Kelly, Giffe T Johnson, Raymond D Harbison
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...
April 2016: Journal of Emergencies, Trauma, and Shock
Echo Fallon, Sierra Fung, Georgina Rubal-Peace, Asad E Patanwala
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)...
April 2016: Advanced Emergency Nursing Journal
Tamika Kelson, Robert Davidson, Tim Baker
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)...
March 2016: Journal of Medical Radiation Sciences
Eva Rojas, Richard Schultz, Heather Heil Linsalata, Debra Sumberg, Maria Christensen, Cathlyn Robinson, Mark Rosenberg
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...
May 2016: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
V Kone, F Lecomte, D Randriamanana, J-L Pourriat, Y-E Claessens, G Vidal-Trecan
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...
April 2016: Revue D'épidémiologie et de Santé Publique
Maher El Chaar, Jill Stoltzfus, Leonardo Claros, Tara Wasylik
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...
April 2016: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Thomas Hubbard, Rhys Thomas
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...
2014: BMJ Quality Improvement Reports
Wesley C Holland, Katherine M Hunold, Sowmya A Mangipudi, Alison M Rittenberg, Natalie Yosipovitch, Timothy F Platts-Mills
OBJECTIVES: Musculoskeletal pain is a common reason for emergency department (ED) visit by older adults. Outpatient pain management following ED visits in this population is challenging as a result of contraindications to, and side effects from, available therapies. Shared decision-making (SDM) between patients and emergency physicians may improve patient experiences and health outcomes. Among older ED patients with acute musculoskeletal pain, we sought to characterize their desire for involvement in the selection of outpatient analgesics...
March 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
David McD Taylor, Daniel M Fatovich, Daniel P Finucci, Jeremy Furyk, Sang-Won Jin, Gerben Keijzers, Stephen Pj Macdonald, Hugh Ma Mitenko, Joanna R Richardson, Joseph Ys Ting, Ogilvie N Thom, Antony M Ugoni, James A Hughes, Nerolie Bost, Meagan L Ward, Clinton R Gibbs, Ellen Macdonald, Dane R Chalkley
OBJECTIVES: We aimed to provide 'adequate analgesia' (which decreases the pain score by ≥2 and by <4 [0-10 scale]) and determine the effect on patient satisfaction. METHODS: We undertook a multicentre, cluster-randomised, controlled, intervention trial in nine EDs. Patients with moderate pain (pain score of ≥4) were eligible for inclusion. The intervention was a range of educational activities to encourage staff to provide 'adequate analgesia'. It was introduced into five early intervention EDs between the 0 and 6 months time points and at four late intervention EDs between 3 and 6 months...
November 24, 2015: Emergency Medicine Australasia: EMA
Aditi Puri Singh, Carlton Haywood, Mary Catherine Beach, Mark Guidera, Sophie Lanzkron, Doris Valenzuela-Araujo, Richard E Rothman, Andrea Freyer Dugas
BACKGROUND: Provider biases and negative attitudes are recognized barriers to optimal pain management in sickle cell disease, particularly in the emergency department (ED). MEASURES: This prospective cohort measures preintervention and postintervention providers' attitudes toward patients with sickle pain crises using a validated survey instrument. INTERVENTION: ED providers viewed an eight-minute online video that illustrated challenges in sickle cell pain management, perspectives of patients and providers, as well as misconceptions and stereotypes of which to be wary...
March 2016: Journal of Pain and Symptom Management
Joseph Herres, Carl R Chudnofsky, Rashmi Manur, Kathia Damiron, Kenneth Deitch
BACKGROUND: Oligoanalgesia challenges emergency department (ED) health care providers and remains an area of patient dissatisfaction. Nitrous oxide (NO) is a safe, quick-acting, and well-tolerated sedative agent with analgesic and anxiolytic properties that make it ideal for ED use. OBJECTIVES: We seek to test the effectiveness of a self-administered and self-contained NO device as an analgesic agent in the ED and assess patient and staff satisfaction with this method...
February 2016: American Journal of Emergency Medicine
Kathryn Eastwood, Amee Morgans, Karen Smith, Angela Hodgkinson, Gareth Becker, Johannes Stoelwinder
Objective The aim of the present study was to describe the Ambulance Victoria (AV) secondary telephone triage service, called the Referral Service (RS), for low-priority patients calling triple zero. This service provides alternatives to ambulance dispatch, such as doctor or nurse home visits.Methods A descriptive epidemiological review of all the cases managed between 2009 and 2012 was conducted, using data from AV case records, the Victorian Admitted Episodes Dataset and the Australian Bureau of Statistics...
November 9, 2015: Australian Health Review: a Publication of the Australian Hospital Association
Selina Ackermann, Anette Heierle, Martina-Barbara Bingisser, Ralph Hertwig, Rakesh Padiyath, Christian Hans Nickel, Wolf Langewitz, Roland Bingisser
In an emergency department (ED), discharge communication represents a crucial step in medical care. In theory, it fosters patient satisfaction and adherence to medication, reduces anxiety, and ultimately promotes better outcomes. In practice, little is known about the extent to which patients receiving discharge information understand their medical condition and are able to memorize and retrieve instructions. Even less is known about the ideal content of these instructions. Focusing on patients with chest pain, we systematically assessed physicians' and patients' informational preferences and created a memory aid to support both the provision of information (physicians) and its retrieval (patients)...
2016: Health Communication
Andrew K Chang, Polly E Bijur, Lynne Holden, E John Gallagher
OBJECTIVES: The objective was to test the hypothesis that oxycodone/acetaminophen provides superior analgesia to hydrocodone/acetaminophen for the treatment of acute extremity pain following emergency department (ED) discharge. METHODS: This was a prospective, randomized, double-blind clinical trial of nonelderly adult ED patients with acute musculoskeletal extremity pain, randomly allocated at discharge to receive oxycodone/acetaminophen (5 mg/325 mg) or hydrocodone/acetaminophen (5 mg/325 mg)...
November 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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