Pain Management in Triage and Reducing Percentage of Left without Being Seen in an Overcrowded ED
Although in most emergency rooms, the patient is seen first by a highly trained triage nurse, the ED physician is trained to determine if the patient can safely leave the ED prior to in-depth exam, treatment and diagnosis. The goal is to keep the left without being seen by a physician percentage low, since a high number would indicate poor quality, additionally patients who present with pain, and then leave the ED prior to being seen can pose a greater risk. This study examined the association of nurse-initiated triage pain protocol on the LWOBS percentage rate of patients who present with a chief complaint of pain in an urban ED located in Southern California, and to identify whether LWOBS can be predicted from the knowledge of an individual's risk factors (age, gender, race/ethnicity), pain severity, pain protocol, and wait time. A test of the full model against a constant only model was statistically significant. Hosmer-Lemeshow test indicated the model was a good fit to the data, and prediction success overall was 86.2%. The most important patient characteristics associated with disposition were treatment in triage and treatment order entry by provider. Treatment in triage was significantly associated with being seen by a physician. These significant findings reflect 94.2% patients who stayed to be seen by the provider were treated in triage for pain. Treatment by provider order entry was highly significant. Results indicate that there is an association between the treatment order entered by provider and if they stayed to be seen. The findings reflected that 71.6% of those who stayed to be seen were treated in triage with an order placed by the physician prior to seeing the physician. Age and gender were not associated with being seen. There was a significant relationship between race/ethnicity and being seen. And this study saw a relationship between LOS and seen. In conclusion, being seen and treated by the physician can decrease the number of return visits through evaluation and referral for underlying etiology of pain. Additional practice implications can include strategies aimed at effective pain management in triage and its impact on length of stay.
Emergency Department, nursing, overcrowding, Pain management, patients, physicians, triage
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