The documentation of pain intensity and its influences on care in the emergency department.

BACKGROUND: Assessment and reassessment of self reported pain intensity scores form the basis of acute pain care in the emergency deprtment (ED), however are frequently undocumented. The effects of not documenting pain assessments on time to first analgesic medication (TTA) and ED length of stay (EDLOS) are unknown. METHODS: This is a retrospective cross-sectional study to investigate the association between documented evidence of pain intensity scores, TTA and EDLOS in the ED. It also examined the factors associated with the documentation of pain intensity scores. Univariate and multivariable modelling was used on a random sample of presentations. RESULTS: There were no statistically significant associations between the documented evidence of pain intensity scores and TTA or EDLOS. Modelling suggests that patients were less likely to have documented evidence of pain intensity scores if they were male, were streamed to the fast-track treatment area, had a lower burden of co-morbidities, or when the general departmental workload was increased. CONCLUSIONS: The documentation of pain intensity scores was not associated with TTA or EDLOS. Some demographic, illness and workload factors are associated with the lack of pain intensity score documentation, however, the effect on patients outcomes needs further investigation.

The relationship between time to analgesic administration and emergency department length of stay: A retrospective review.

AIM: To determine the association between time to first analgesic medication and emergency department length of stay (ED LOS). DESIGN: Retrospective cohort study. METHOD: We conducted this study in a large, inner-city emergency department and included adult patients who presented with pain as a symptom and received analgesic medication(s). Study participants were identified from a random selection of 2,000 adult patients who presented between August-October 2018. The relationship between ED LOS and time to first analgesic medication was described using bivariate and multivariate linear regression. RESULTS: Of the 2,000 randomly selected patients presenting between August and October 2018, 727 (36.35%) had pain as a symptom on arrival, 423 (21.15%) had analgesic medication administered. The median time to first analgesic medication was in 62 (interquartile range: 36-105) minutes and median ED LOS was 218 (interquartile range: 160-317.5) minutes. After adjusting for the effects of sex, urgency of the presentation, emergency department location first seen by clinician, departure destination and workload metrics (average daily time to be seen and daily access block). Time to first analgesic medication was independently associated with ED LOS, contributing to 6.96% of the variance in the multivariate model. CONCLUSION: Providing analgesic medication faster to patients presenting in pain, in addition to previously demonstrated positive patient outcomes, may decrease their ED LOS. IMPACT: Reducing ED LOS through faster pain care, benefits the patient through faster pain relief and can benefit the department by reducing the total amount of care delivered in the emergency department. Reducing total care delivery frees up resources to improve the care to all emergency department patients.