Do Ethnic Differences Still Exist in Pain Assessment in the ED?
Although the provision of timely and appropriate analgesia is a primary goal of Emergency Department (ED) staff, pain continues to be undertreated and some evidence supports the existence of pain treatment disparities. Despite strong incentives from accreditation organizations, pain management in the ED may still be inconsistent and problematic. The purpose of this research study was to conduct a retrospective chart review to investigate pain assessment and treatment for 200 adults (≥18 years old) admitted to the ED suffering from long-bone fractures. An additional purpose was to investigate demographic variables, including ethnicity, to determine if they influenced pain assessment, pain treatment, and wait times in the ED. Although assessment and treatment of pain is universally recognized as being important and necessary to provide optimal patient care, only 52% of patients in this study were assessed using a pain intensity scale, with 43% of those assessed reporting pain as ≥5 on a 0–10 pain intensity instrument. Pain medication was administered to 75% of the patients, but 25% of the patients received no medication. Only 24% of those receiving a pain medication were reassessed to determine pain relief. Compounding these problems were wait times for analgesia of >1 hour. Although the influence on pain management related to ethnicity was not a factor in this study, other findings revealed that undertreatment of pain, inadequate assessment, lack of documentation of pain, and lengthy wait times persist in the ED.
Although the provision of timely and appropriate analgesia is a primary goal of Emergency Department (ED) staff, pain continues to be undertreated (Bauman et al., 2007, Herr and Titler, 2009, Hwang et al., 2006, Kelly, 2000, Pletcher et al., 2008, Ritsema et al., 2007, Rupp and Delaney, 2004, Tamayo-Sarver et al., 2003, Todd et al., 2007, Todd, 2001; Todd, Deaton, D'Adamo, and Goe, 2000; Todd, Samaroo, and Hoffman,1993). Compounding this problem of undertreatment are long wait times before analgesics administration. Findings from earlier research studies indicate that patients wait on the average >1 hour for first medication when presenting to the ED (Grant, 2006, Epps et al., 2008). Despite policies, protocols, and guidelines mandating pain assessment and treatment for patients, undertreatment of pain and inadequate assessment and documentation of pain persist in the ED (Colley and Crouch, 2000, Epps et al., 2008). One possible contributing factor to the problem of oligoanalgesia is the existence of ethnic disparities in treatment of pain (Harrison & Falco, 2005; Institute of Medicine [IOM], 2003; U.S. Department of Health & Human Services, 2005) regardless of whether the disparities are intentional or not. A body of evidence suggests inadequate analgesia for ethnic and minority patients (Bonham, 2001, Cintron and Morrison, 2006, Ducharme, 2005, Neighbor et al., 2004; Silka et al. 2004; Tamayo-Sarver et al., 2003, Todd et al., 1993, Todd, Lee, & Hoffman, 1994; Todd et al., 2000, Weisse et al., 2001, Weisse et al., 2003). The purpose of the present research study was to investigate pain assessment and treatment for adult patients (≥18 years old) who were admitted to the ED suffering from long-bone fractures (LBFs). An additional purpose was to determine if ethnic disparities were evident in the assessment and treatment process.
Abstract and Introduction
Abstract
Although the provision of timely and appropriate analgesia is a primary goal of Emergency Department (ED) staff, pain continues to be undertreated and some evidence supports the existence of pain treatment disparities. Despite strong incentives from accreditation organizations, pain management in the ED may still be inconsistent and problematic. The purpose of this research study was to conduct a retrospective chart review to investigate pain assessment and treatment for 200 adults (≥18 years old) admitted to the ED suffering from long-bone fractures. An additional purpose was to investigate demographic variables, including ethnicity, to determine if they influenced pain assessment, pain treatment, and wait times in the ED. Although assessment and treatment of pain is universally recognized as being important and necessary to provide optimal patient care, only 52% of patients in this study were assessed using a pain intensity scale, with 43% of those assessed reporting pain as ≥5 on a 0–10 pain intensity instrument. Pain medication was administered to 75% of the patients, but 25% of the patients received no medication. Only 24% of those receiving a pain medication were reassessed to determine pain relief. Compounding these problems were wait times for analgesia of >1 hour. Although the influence on pain management related to ethnicity was not a factor in this study, other findings revealed that undertreatment of pain, inadequate assessment, lack of documentation of pain, and lengthy wait times persist in the ED.
Introduction
Although the provision of timely and appropriate analgesia is a primary goal of Emergency Department (ED) staff, pain continues to be undertreated (Bauman et al., 2007, Herr and Titler, 2009, Hwang et al., 2006, Kelly, 2000, Pletcher et al., 2008, Ritsema et al., 2007, Rupp and Delaney, 2004, Tamayo-Sarver et al., 2003, Todd et al., 2007, Todd, 2001; Todd, Deaton, D'Adamo, and Goe, 2000; Todd, Samaroo, and Hoffman,1993). Compounding this problem of undertreatment are long wait times before analgesics administration. Findings from earlier research studies indicate that patients wait on the average >1 hour for first medication when presenting to the ED (Grant, 2006, Epps et al., 2008). Despite policies, protocols, and guidelines mandating pain assessment and treatment for patients, undertreatment of pain and inadequate assessment and documentation of pain persist in the ED (Colley and Crouch, 2000, Epps et al., 2008). One possible contributing factor to the problem of oligoanalgesia is the existence of ethnic disparities in treatment of pain (Harrison & Falco, 2005; Institute of Medicine [IOM], 2003; U.S. Department of Health & Human Services, 2005) regardless of whether the disparities are intentional or not. A body of evidence suggests inadequate analgesia for ethnic and minority patients (Bonham, 2001, Cintron and Morrison, 2006, Ducharme, 2005, Neighbor et al., 2004; Silka et al. 2004; Tamayo-Sarver et al., 2003, Todd et al., 1993, Todd, Lee, & Hoffman, 1994; Todd et al., 2000, Weisse et al., 2001, Weisse et al., 2003). The purpose of the present research study was to investigate pain assessment and treatment for adult patients (≥18 years old) who were admitted to the ED suffering from long-bone fractures (LBFs). An additional purpose was to determine if ethnic disparities were evident in the assessment and treatment process.
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