ED triage pain protocol reduces time to receiving analgesics in patients with painful conditions

Aaron N Barksdale, Jeff Lee Hackman, Karen Williams, Matt Christopher Gratton

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background Studies suggest that collaborative nursing protocols initiated in triage improve emergency department (ED) throughput and decrease time to treatment. Objective The objective of the study is to determine if an ED triage pain protocol improves time to provision of analgesics. Methods Retrospective data abstracted via electronic medical record of patients at a safety net facility with 67 000 annual adult visits. Patients older than 18 years who presented to the ED between March 1, 2011, and May 31, 2013, with 1 of 6 conditions were included: back pain, dental pain, extremity trauma, sore throat, ear pain, or pain from an abscess. A 3-month orientation to an ED nurse-initiated pain protocol began on March 1, 2012. Nurses administered oral analgesics per protocol, beginning with acetaminophen or ibuprofen and progressing to oxycodone. Preimplementation and postimplementation analyses examined differences in time to analgesics. Multivariable analysis modeled time to analgesics as a function of patient factors. Results Over a 27-month period, 23 409 patients were included: 13 112 received pain medications and 10 297 did not. A total of 12 240 (52%) were male, 12 578 (54%) were African American, and 7953 (34%) were white, with a mean (SD) age of 39 years (13 years). The pain protocol was used in 1002 patients. There was a significant change in mean time (minutes) to provision of analgesics between preimplementation (238) and postimplementation (168) (P <.0001). Linear regression showed the protocol-delivered medications to younger patients and of lower acuity in a reduced time. Variables not related to time to provision of medication included sex, payer, and race. Conclusion Emergency department triage pain protocol decreased time to provision of pain medications and did so without respect to payer category, sex, or race.

Original languageEnglish (US)
Pages (from-to)2362-2366
Number of pages5
JournalAmerican Journal of Emergency Medicine
Volume34
Issue number12
DOIs
StatePublished - Dec 1 2016

Fingerprint

Triage
Analgesics
Hospital Emergency Service
Pain
Nurses
Patient Acuity
Nursing Assessment
Oxycodone
Pharyngitis
Electronic Health Records
Ibuprofen
Back Pain
Acetaminophen
African Americans
Abscess
Ear
Linear Models
Tooth
Extremities
Safety

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

ED triage pain protocol reduces time to receiving analgesics in patients with painful conditions. / Barksdale, Aaron N; Hackman, Jeff Lee; Williams, Karen; Gratton, Matt Christopher.

In: American Journal of Emergency Medicine, Vol. 34, No. 12, 01.12.2016, p. 2362-2366.

Research output: Contribution to journalArticle

Barksdale, Aaron N ; Hackman, Jeff Lee ; Williams, Karen ; Gratton, Matt Christopher. / ED triage pain protocol reduces time to receiving analgesics in patients with painful conditions. In: American Journal of Emergency Medicine. 2016 ; Vol. 34, No. 12. pp. 2362-2366.
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abstract = "Background Studies suggest that collaborative nursing protocols initiated in triage improve emergency department (ED) throughput and decrease time to treatment. Objective The objective of the study is to determine if an ED triage pain protocol improves time to provision of analgesics. Methods Retrospective data abstracted via electronic medical record of patients at a safety net facility with 67 000 annual adult visits. Patients older than 18 years who presented to the ED between March 1, 2011, and May 31, 2013, with 1 of 6 conditions were included: back pain, dental pain, extremity trauma, sore throat, ear pain, or pain from an abscess. A 3-month orientation to an ED nurse-initiated pain protocol began on March 1, 2012. Nurses administered oral analgesics per protocol, beginning with acetaminophen or ibuprofen and progressing to oxycodone. Preimplementation and postimplementation analyses examined differences in time to analgesics. Multivariable analysis modeled time to analgesics as a function of patient factors. Results Over a 27-month period, 23 409 patients were included: 13 112 received pain medications and 10 297 did not. A total of 12 240 (52{\%}) were male, 12 578 (54{\%}) were African American, and 7953 (34{\%}) were white, with a mean (SD) age of 39 years (13 years). The pain protocol was used in 1002 patients. There was a significant change in mean time (minutes) to provision of analgesics between preimplementation (238) and postimplementation (168) (P <.0001). Linear regression showed the protocol-delivered medications to younger patients and of lower acuity in a reduced time. Variables not related to time to provision of medication included sex, payer, and race. Conclusion Emergency department triage pain protocol decreased time to provision of pain medications and did so without respect to payer category, sex, or race.",
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