The Effect of a Nurse Initiated Therapeutic Conversation Compared to Standard Care for Patients With Acute Pain in the ED: A Randomized Controlled Trial.

Acute pain is a common presenting complaint in the emergency department (ED) and is most often treated with opioid or nonopioid analgesia. However, studies have shown that receiving analgesia alone does not always influence patient satisfaction with pain management in the ED. Pain anxiety and catastrophizing have been shown to affect pain intensity and patients' response to analgesia. The objective of this study was to determine whether a brief therapeutic conversation would improve patient satisfaction with pain management compared with standard care for adult patients presenting to the ED with moderate to severe acute pain. Adult (18 years or older) patients presenting to the ED with moderate to severe acute pain were randomized to either the standard care group or the intervention group. Patients in the intervention group participated in a brief therapeutic conversation with an ED nurse to discuss their perceived cause of pain, level of anxiety, and expectations of their pain management. Prior to discharge, all patients were asked to complete a self-reported, 9-item questionnaire to assess their level of satisfaction with their overall ED experience. A total of 166 patients (83 in each group) were enrolled. Patient satisfaction with ED pain management and the proportion of patients who received analgesia in the ED were similar in both the control (n = 57; 68.7%) and intervention (n = 58; 69.9%) groups (Δ 1.2%; 95% CI [12.6, 15]). Qualitative findings demonstrate that patients place high importance on acknowledgment from ED staff and worry about the unknown cause of pain. This study suggests that patient satisfaction with pain management in the ED is multifactorial and complex. Further research should investigate additional methods of integrating nurse-led interventions into the care of patients in acute pain.

Identification of seniors at risk (ISAR) screening tool in the emergency department: implementation using the plan-do-study-act model and validation results.

INTRODUCTION: To better meet the needs of older adults in the emergency department, Senior Friendly care processes, such as high-risk screening are recommended. The identification of Seniors at Risk (ISAR) tool is a 6-item validated screening tool for identifying elderly patients at risk of the adverse outcomes post-ED visit. This paper describes the implementation of the tool in the Mount Sinai Hospital emergency department using a Plan-Do-Study-Act model; and demonstrates whether the tool predicts adverse outcomes. METHODS: An observational study tracked tool implementation. A retrospective chart audit was completed to collect data about elderly ED patients during 2 time periods in 2010 and 2011. Data analysis compared the characteristics of patients with positive and negative screening tool results. RESULTS: The identification of Seniors at Risk tool was completed for 51.6% of eligible patients, with 61.2% of patients having a positive result. Patients with positive screening results were more likely to be over age 79 (P = .003); be admitted to hospital (P < .001); have a longer mean ED length of stay (P < .001). For patients admitted to hospital, those with positive screening results had a longer mean inpatient stay (P = .012). DISCUSSION: Implementing the Idenfitication of Seniors at Risk tool was challenged by problematic compliance with tool completion. Strategies to address this included tool adaptation; and providing staff with knowledge of ED and inpatient geriatric resources and feedback on completion rates. Positive screening results predicted adverse outcomes in elderly Mount Sinai Hospital ED patients.