The National Trend in Quality of Emergency Department Pain Management for Long Bone Fractures

Tamara S. Ritsema, Gabor D. Kelen, Peter J. Pronovost, Julius Cuong Pham

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Background: Despite national attention, there is little evidence that the quality of emergency department (ED) pain management is improving. Objectives: To compare the quality of ED pain management before and after implementation of the Joint Commission on the Accreditation of Healthcare Organizations' standards in 2001. Methods: The authors performed a retrospective cohort study by using the National Hospital Ambulatory Medical Care Survey from 1998-2003. Patients who presented to the ED with a long bone fracture (femur, humerus, tibia, fibula, radius, or ulna) were compared. The authors extracted data on patient, visit, and hospital characteristics. The primary outcomes were the proportion of patients who received assessment of pain severity and who received analgesic treatment. Results: There were 2,064 patients with a qualifying fracture in the study period, 834 from 1998-2000 and 1,230 from 2001-2003. Compared with the early period, a higher proportion of patients in the late period had their pain assessed (74% vs. 57%), received opiates (56% vs. 50%), and received any analgesic (76% vs. 56%). Patients in the late period had higher odds of receiving any analgesia (adjusted odds ratio [OR], 1.43) and opioid analgesia (adjusted OR, 1.27) compared with the early period. Patients in the middle age group (adjusted OR, 2.28) or those seen by physician assistants (adjusted OR, 2.05) were more likely, whereas those with Medicaid (adjusted OR, 0.58) and those in the Northeast were less likely, to receive opiates. Conclusions: Although the quality of ED pain management for acute fractures appears to be improving, there is still room for further improvement.

Original languageEnglish (US)
Pages (from-to)163-169
Number of pages7
JournalAcademic Emergency Medicine
Volume14
Issue number2
DOIs
StatePublished - Feb 1 2007

Fingerprint

Bone Fractures
Pain Management
Hospital Emergency Service
Odds Ratio
Opiate Alkaloids
Analgesia
Analgesics
Joint Commission on Accreditation of Healthcare Organizations
Health Care Surveys
Physician Assistants
Ulna
Fibula
Humerus
Medicaid
Pain Measurement
Tibia
Femur
Opioid Analgesics
Cohort Studies
Retrospective Studies

Keywords

  • emergency department
  • pain assessment
  • pain treatment
  • quality of care

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

The National Trend in Quality of Emergency Department Pain Management for Long Bone Fractures. / Ritsema, Tamara S.; Kelen, Gabor D.; Pronovost, Peter J.; Pham, Julius Cuong.

In: Academic Emergency Medicine, Vol. 14, No. 2, 01.02.2007, p. 163-169.

Research output: Contribution to journalArticle

Ritsema, Tamara S. ; Kelen, Gabor D. ; Pronovost, Peter J. ; Pham, Julius Cuong. / The National Trend in Quality of Emergency Department Pain Management for Long Bone Fractures. In: Academic Emergency Medicine. 2007 ; Vol. 14, No. 2. pp. 163-169.
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