Sunday, February 10, 2008

Pain in the Emergency Department

Overcrowding in the Emergency Room causes many problems. Untreated pain is an emergency.

See article below regarding very poor pain management in overcrowded ER's. If OSF's administration had a little more untreated pain during their ER visits, that may have helped the general public in Peoria.

ED Crowding and Pain Management

Crowding is associated with nontreatment and delayed treatment of severe pain.

Inadequate pain management in the emergency department has received much attention recently, including by the Joint Commission. ED crowding is one of the many postulated contributors to inadequate or delayed emergency pain management. In a retrospective study of nearly 14,000 patients who presented to an urban ED with severe pain (score of 9 or 10 on a 10-point scale), the authors examined whether ED crowding contributed to delayed pain management. The two measures of delay were administration of pain medication more than 1 hour after triage and administration more than 1 hour after arrival in a treatment area. Measures of crowding were ED occupancy, total number of patients in the waiting room, and aggregate number of patient hours (length of stay) for all patients in the ED at the time the study patient presented.

During the 17-month study period, 49% of patients who reported severe pain received analgesia. Of those, 79% experienced delays: 59% waited more than 1 hour after triage, and 20% waited more than 1 hour after arrival in a treatment area. Number of patients in the waiting room and ED occupancy were independently associated with both nontreatment of pain and delayed treatment.

Comment: ED crowding, in addition to being a growing problem and a symptom of a struggling healthcare system, might be associated with delay in pain treatment. Strategies to address severe-pain treatment in the setting of ED crowding include providing physicians or physician extenders at triage to initiate therapy and instituting standing orders for the administration of analgesia. As we all struggle to find creative ways to treat time-dependent disease in an increasingly constrained environment, we must keep in mind that 10/10 pain is a true emergency, every bit as pressing as chest pain, symptoms meeting "trauma team" criteria, or community-acquired pneumonia. The mystery in this study, though, is why 51% of patients who reported 9/10 or 10/10 pain did not receive any analgesia at all, crowded ED or not!

— Richard D. Zane, MD, FAAEM

Published in Journal Watch Emergency Medicine February 8, 2008

Pines JM and Hollander JE. Emergency department crowding is associated with poor care for patients with severe pain. Ann Emerg Med 2008 Jan; 51:1.

Monday, February 4, 2008

OSF Continues Dangerous Policy

I have a family member who has been very sick for the past 6 months.

This person is followed by an OSF physician who we have known and trusted for years. I sent this OSF physician an e mail the other day at his OSF e mail address.

This e mail contained an up to date medical problem list to keep him totally informed regarding the family member’s acute and chronic problems. It explained how she was regarding vital signs, oxygen level, blood tests, medications, diet, activity, etc. A very important e mail.

He did not receive my e mail at his OSF address. So I sent it again to his personal e mail address and he did receive it.

The OSF physician called me Sunday night (last night) to discuss at length each medical problem on the list. They are all important.

My wife was followed by an OSF provider as well. Her e mails went unanswered by the provider because he did not receive them.

My son, did not receive his surgery at OSF last summer. Time drug on as documented on a former post. So we took him out of state to a well known pediatric center where he was taken care of very quickly.

My e mails have been blocked by OSF which is of course obstructing medical communication with my family and their doctors.

In the meantime Haitian Hearts patients continue to suffer and die in Haiti due to OSF’s policy of rejecting all of my patients.

The founding Sisters of the Third Order of OSF would not be happy about how their hospital, founded on a philosophy of love, is actually functioning in 2008.