Prospective analysis of pain and pain management in an emergency department.

. BACKGROUND AND AIM OF THE WORK: The aim of pain management in the Emergency Department (ED) is to temporarily optimize patient quality of life by reducing acute discomfort. The goals of this study were to evaluate the intensity and location of pain experienced by patients in the ED, the time to analgesia administration in the ED, and the patient's satisfaction so to identify potential useful interventions to improve pain management. METHODS: We prospectively collected data on the intensity of pain experienced by 137 patients during their ED stays using the Visual Analog Scale (VAS) and the Numeric Rating Scale (NRS). Patients were further stratified by pain intensity according to three categories, and by cause of pain. RESULTS: NRS pain measurements were higher than VAS measurements. Patients who took pain medication within a few hours before their ED visit had a higher mean VAS score at arrival in comparison to patients who did not. Patients treated with pain medications, compared to the non-treated, had more pain at arrival; abdominal pain was treated earlier than non-abdominal pain, whereas no difference in timing of medication administration was noted between traumatic and non-traumatic pain. Among the  hospitalized patients, the chest was the most common location of pain; these patients had lower NRS scores than non-hospitalized patients. Patients with mild to moderate pain were more satisfied then those with severe pain. CONCLUSIONS: The discrepancy between NRS and VAS scores suggests that pain intensity cannot be determined accurately according to pain scale data alone but should also incorporate clinical judgment.

Geographic information system data from ambulances applied in the emergency department: effects on patient reception.

BACKGROUND: Emergency departments (ED) recognize crowding and handover from prehospital to in-hospital settings to be major challenges. Prehospital Geographical Information Systems (GIS) may be a promising tool to address such issues. In this study, the use of prehospital GIS data was implemented in an ED in order to investigate its effect on 1) wait time and unprepared activations of Trauma Teams (TT) and Medical Emergency Teams (MET) and 2) nurses' perceptions regarding patient reception, workflow and resource utilization. INTERVENTION: From May 1st 2014 to October 31th 2014, GIS data was displayed in the ED. Data included real-time estimated time of arrival, distance to ED, dispatch criteria, patient data and ambulance contact information. Data was used by coordinating nurses for time activation of TT and MET involved in the initial treatment of severely-injured or critically-ill patients. In addition, it was used as a logistics tool for handling all other patients transported by ambulance to the ED. STUDY DESIGN: The study followed a mixed-methods design, consisting of a quantitative study (before and after intervention) and a qualitative study (survey and interviews). PARTICIPANTS: Participants included all patients received by TT or MET and coordinating nurses in the ED. RESULTS: 1.) Quantitative: 599 patients were included. The median wait time for TT and MET was 5 min both before and after the GIS intervention, showing no difference (p = 0.18). A significant reduction in the subgroup of waits >10 min was found (p < 0.05). No difference was found in unprepared TT and MET activations. 2.) Qualitative: Nurses perceived GIS data as a tool to optimize resource utilization and quality of all patients' reception, critically or non-critically ill. No substantial disadvantages were reported. DISCUSSION: The contradiction of measured median wait time and nurses perceived improved timing of team activation may result from having both RT- ETA and supplemental patient information not only for seriously-injured or critically-ill patients received by the TT and MET, but for all patients transported by ambulance. The reduction in waits > 10 minutes may have contributed to the overall perception of reduced wait time, as avoidance of long waits is clinically more important than reduction in the median wait time. CONCLUSION: A comparison of the use of prehospital GIS data in the ED with the control period showed no effect on median wait time for TT and MET, however, the number of waits of >10 min was reduced. On the other hand, nurses perceived implementation of GIS data as improving workflow, resource utilization and quality of all patients' reception, critically as well as non-critically ill. There were no substantial disadvantages to the GIS application. TRIAL REGISTRATION: ClinicalTrials.gov (NCT02188966).

Timing of pulmonary embolism diagnosis in the emergency department.

BACKGROUND: Patients with pulmonary embolism(PE) benefit from rapid diagnosis and treatment. The aim of the present study is to examine factors that contribute to the time between admission at the emergency department and diagnosis of PE (=time to diagnosis TTD). METHODS: This retrospective study included 241 patients with symptomatic PE that were admitted at the emergency department. Patient records were reviewed to obtain the relevant clinical information. Patients were assigned in one of three groups according to their TTD: short TTD ≤ 2 h; intermediate TTD N 2 h and ≤ 12 h; and prolonged TTD N 12 h. The groups were compared for differences in clinical factors. Furthermore multiple linear regression analyses based on TTD was performed. RESULTS: Factor that significantly contribute to a very short TTD b 2 h are tachycardia and a high embolus burden. Factors that significantly contribute to a diagnosis b12 h are embolus burden, no COPD present, patient admitted at day shift, and a less pathologic ratio of ventricle axis. Multiple regression analyses identified increased age and low embolus burden as the strongest, independent factors for prolonged TTD. CONCLUSIONS: Patients with higher embolus load or signs of severe PE including tachycardia were most likely diagnosed within 2 h after presentation.More effort should be put in a faster diagnostic process in older patients and in patients with COPD.