Pathways and protocols for the triage patient with acute pain
SCOPE OF THE PROBLEM Emergency departments (EDs) face many challenges. Recent data suggest that patient visits in United States EDs have increased 18% over the past 10 years and are now estimated to approximate 110 million visits annually. Pain is the most common symptom in which patients present to the ED. Up to 78% of all patients present to the ED with a chief complaint of pain. Emergency providers have an important opportunity to intervene with analgesic agents at triage to provide analgesia to patients suffering pain. To affect this scheme, there is a need for nurse-driven analgesic protocols at triage. Overcrowding ED crowding has recently been recognized as a critical problem by the Institute of Medicine. A national survey of eight EDs reported experiencing overcrowding 12-73% of the time (mean = 35%). A direct consequence of ED overcrowding is a prolonged time to evaluation by a physician. Variability at individual institutions is common, and data from a prospective study conducted at a single site reports an average time to initial analgesic of 74 min. Time to pain assessment is also affected by ED overcrowding. Elderly patients with hip fractures have been described as experiencing significantly longer time to pain assessment when the ED is at capacity. Delays associated with overcrowding leave many patients in the waiting room after the initial triage assessment by a nurse. Patients with pain are forced to wait for physician evaluation and potential pain relief.
