Pain in an emergency department: an audit

Abstract

Objective: To evaluate the quality of care in patients with pain who visit the emergency department of a university hospital and the evolution of their pain during their emergency department stay.

Methods: A cross-sectional survey was performed using two valid scales (a numerical descriptor scale or a verbal pain intensity scale), and a structured questionnaire to patients and use of patient charts to collect information on pain intensity on arrival and before discharge, characteristics of pain and of its management.

Results: In the 726 participating patients, median age was 37 years (range: 18-97), and 54% of the patients were men. Upon arrival, 563 patients presented with pain (78%), rated > or =7 in 35% of the 390 patients evaluated using numerical descriptor scale. Forty-four percent had taken analgesics before arrival. Their median waiting time before initial medical examination was 30 min. Pain was identified by triage nurses (70%) or by physicians (77%) and was rated by nurses (23%) and physicians (11%). Forty-seven percent also experienced pain during care and 27% received analgesics during their stay. Pain intensity remained unchanged in 70% of patients, increased in 7% and decreased in 23%. Of the 480 patients with pain on arrival evaluated before discharge, 395 (82%) patients were unrelieved before going home, rated > or =7 in 32% of the 390 patients evaluated using numerical descriptor scale. Analgesics were ordered before leaving the emergency department in 81%.

Conclusion: Even if pain has been identified, its assessment and management remains inadequate. The quality of care may be improved by educating the personnel in developing protocols and in evaluating pain management.