Abstract:Objectives: The objectives were to report the baseline (prior to quality improvement interventions) patient and visit characteristics and analgesic management practices for each site participating in an emergency department (ED) sickle cell learning collaborative.Methods: A prospective, multisite longitudinal cohort study in the context of a learning-collaborative model was performed in three midwestern EDs. Each site formed a multidisciplinary team charged with improving analgesic management for patients with… Show more
“…Several studies in the surgical literature (14,15) have demonstrated the potential for "fast-tracking" postoperative patients with some success. Additionally, in patients with sickle-cell disease, a lot of research in emergency rooms and outpatient and inpatient settings has been focused on developing the best collaborative approach to minimize resource utilization and improve pain control (16)(17)(18). Another significant issue in IBD patients is nutrition.…”
“…Several studies in the surgical literature (14,15) have demonstrated the potential for "fast-tracking" postoperative patients with some success. Additionally, in patients with sickle-cell disease, a lot of research in emergency rooms and outpatient and inpatient settings has been focused on developing the best collaborative approach to minimize resource utilization and improve pain control (16)(17)(18). Another significant issue in IBD patients is nutrition.…”
“…Three studies in the United States of America (USA): Benjamin et al (2000), Tanabe et al (2007) and Tanabe et al (2010) reported achieving initiation within 20 minutes, 90 minutes and 74 minutes, respectively (11,14,15). The results of this survey showed mean times to initiation of analgesic therapy of 38 minutes and 111 minutes at SCU and A&E, respectively.…”
Section: Side Effectsmentioning
confidence: 68%
“…The results of this survey showed mean times to initiation of analgesic therapy of 38 minutes and 111 minutes at SCU and A&E, respectively. Possible reasons for delays in the initiation of therapy proffered by Tanabe et al (14,15) include over-crowding and "under-triage" or the assigning of a lower priority level. Interestingly, negative attitudes toward "frequent attenders" were not cited as a cause for delay by Tanabe et al (14,15).…”
Section: Side Effectsmentioning
confidence: 99%
“…Possible reasons for delays in the initiation of therapy proffered by Tanabe et al (14,15) include over-crowding and "under-triage" or the assigning of a lower priority level. Interestingly, negative attitudes toward "frequent attenders" were not cited as a cause for delay by Tanabe et al (14,15). It could be argued, however, that "under-triage" was the manifestation of the negative perception of SCD patients that abound in the literature (16−19) and can affect perceptions and assessment of priority.…”
“…The agent does seem to be gaining popularity for use in the ED, for reasons that are both evidence based and anecdotal. The evidence basis for hydromorphone use in the ED is long standing and broad, for indications ranging from renal colic [189] to sickle cell crisis [190]. As for the anecdotal reasons for hydromorphone's growing popularity, some physicians (including this author) have found that hydromorphone use can be a route around inappropriately overcautious nurses who (despite requests to the contrary) split 0.1 mg/kg morphine orders into nearhomeopathic doses administered over 15-30 minutes "for safety. "…”
Since pain is a primary impetus for patient presentation to the Emergency Department (ED), its treatment should be a priority for acute care providers. Historically, the ED has been marked by shortcomings in both the evaluation and amelioration of pain. Over the past decade, improvements in the science of pain assessment and management have combined to facilitate care improvements in the ED. The purpose of this review is to address selected topics within the realm of ED pain management. Commencing with general principles and definitions, the review continues with an assessment of areas of controversy and advancing knowledge in acute pain care. Some barriers to optimal pain care are discussed, and potential mechanisms to overcome these barriers are offered. While the review is not intended as a resource for specific pain conditions or drug information, selected agents and approaches are mentioned with respect to evolving evidence and areas for future research.
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