Crowding in EDs has led to a decrease in the timely and effective use of pain medication in children suffering acute long bone fractures, according to a new study.
“Pain associated with long bone fractures can be pretty severe,” said Marion Sills, MD, MPH, the lead author of the study by researchers with the University of Colorado School of Medicine. “But crowded emergency departments are impacting the delivery of care on many levels, including the delivery of pain medication.”
The researchers said they focused on long bone fractures because they are common among children and very painful.
Sills, associate professor of pediatrics at the CU School of Medicine, led a study of 1,229 patients treated in the ED of an academic children’s hospital over a year-long period.
She found that patients were 4% to 47% less likely to receive timely care, depending on the specific quality measure, and 3% to 17% percent less likely to receive effective care when crowding was at the 90th rather than the 10th percentile.
Five previous studies have shown that crowded EDs lead to lower levels of pain control among adult patients. But this was the first time researchers investigated the impact of crowding on children with fracture-related pain.
“We found that crowding can lower the likelihood of timely treatment by as much as 47% and raise the likelihood of non-treatment by as much as 17%,” Sills said in a news release. “The relationship between emergency department crowding and pain treatment is not unexpected. When the emergency department gets busier, staff may be less responsive to the needs of individual patients, and as a result, patients have a higher likelihood of non-treatment and delays in treatment.”
Sills did not study the reasons behind the association for the article, which appears in the December issue of Academic Emergency Medicine, but noted one possible issue is the deployment of hospital staff. In some settings, hospital policy permits nurses to administer analgesia to patients meeting specific criteria. But in some EDs, only doctors can authorize the use of potent opioids for pain.
“The expensive way to mitigate crowding is to hire more staff,” Sills said. “Another way is to leverage the staff you have. Institutions can use techniques like protocols for pain management with standing orders for nurses, and computer- or phone-based alerts to call attention to under-treated pain.”
Another idea is to create incentives for patients to seek care at their own doctor’s office, Sills said, citing better compensation for primary care and disincentives for non-emergency use of EDs as examples.
To read a study summary and access the study via subscription or purchase, visit http://bit.ly/ukleva.
“Pain associated with long bone fractures can be pretty severe,” said Marion Sills, MD, MPH, the lead author of the study by researchers with the University of Colorado School of Medicine. “But crowded emergency departments are impacting the delivery of care on many levels, including the delivery of pain medication.”
The researchers said they focused on long bone fractures because they are common among children and very painful.
Sills, associate professor of pediatrics at the CU School of Medicine, led a study of 1,229 patients treated in the ED of an academic children’s hospital over a year-long period.
She found that patients were 4% to 47% less likely to receive timely care, depending on the specific quality measure, and 3% to 17% percent less likely to receive effective care when crowding was at the 90th rather than the 10th percentile.
Five previous studies have shown that crowded EDs lead to lower levels of pain control among adult patients. But this was the first time researchers investigated the impact of crowding on children with fracture-related pain.
“We found that crowding can lower the likelihood of timely treatment by as much as 47% and raise the likelihood of non-treatment by as much as 17%,” Sills said in a news release. “The relationship between emergency department crowding and pain treatment is not unexpected. When the emergency department gets busier, staff may be less responsive to the needs of individual patients, and as a result, patients have a higher likelihood of non-treatment and delays in treatment.”
Sills did not study the reasons behind the association for the article, which appears in the December issue of Academic Emergency Medicine, but noted one possible issue is the deployment of hospital staff. In some settings, hospital policy permits nurses to administer analgesia to patients meeting specific criteria. But in some EDs, only doctors can authorize the use of potent opioids for pain.
“The expensive way to mitigate crowding is to hire more staff,” Sills said. “Another way is to leverage the staff you have. Institutions can use techniques like protocols for pain management with standing orders for nurses, and computer- or phone-based alerts to call attention to under-treated pain.”
Another idea is to create incentives for patients to seek care at their own doctor’s office, Sills said, citing better compensation for primary care and disincentives for non-emergency use of EDs as examples.
To read a study summary and access the study via subscription or purchase, visit http://bit.ly/ukleva.
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