The effect of emergency department crowding on the management of pain in older adults with hip fracture
The effect of emergency department crowding on the management of pain in older adults with hip fracture
复制标题
DOI：
10.1111/j.1532-5415.2005.00587.x
复制
发表时间：
2006-02-01
影响因子：
6.3
通讯作者：
Morrison, RS
中科院分区：
文献类型：
--
作者：
Hwang, U;Richardson, LD;Morrison, RS
目的：评估急诊科（艾德）拥挤对老年人疼痛评估和治疗的影响。设计：回顾性回顾前瞻性队列研究的艾德记录。地点：城市，学术附属，三级医疗中心。参与者：158例患者，年龄50岁及以上，接受评估并住院治疗的艾德髋部骨折。测量：患者相关风险因素：年龄、性别、疗养院住所、艾德分诊状态、痴呆、老年急性生理学和慢性健康评估II生理学评分和兰德合并症评分。艾德拥挤危险因素：艾德人口普查和平均住院时间。成果：记录疼痛评估、疼痛评估时间、疼痛治疗时间、报告疼痛接受镇痛的患者以及度冷丁的使用。结果：平均年龄为83岁（范围52-101），81.0%的患者主诉疼痛，疼痛评估的平均时间为40分钟（范围0-600），治疗时间为141分钟（范围10-525），平均治疗延迟为122分钟（范围0-526）。在疼痛患者中，35.9%未接受镇痛，7.0%接受非阿片类药物，57.0%接受阿片类药物。在接受阿片类药物的患者中，32.8%接受哌替啶。艾德拥挤在人口普查水平大于120%的床位容量与疼痛评估的可能性较低（P=.05）和疼痛评估的时间较长（P=.01）显著相关。结论：髋部骨折的老年人有疼痛评估不足的风险，疼痛被确定后镇痛剂给药的相当大的延迟，以及使用不适当的镇痛剂（例如，较高水平的艾德普查与较差的疼痛管理显著相关。
OBJECTIVES: To evaluate the effect of emergency department (ED) crowding on assessment and treatment of pain in older adults.DESIGN: Retrospective review of ED records from a prospective cohort study.SETTING: Urban, academically affiliated, tertiary medical center.PARTICIPANTS: One hundred fifty-eight patients, aged 50 and older, evaluated and hospitalized from the ED with hip fracture.MEASUREMENTS: Patient-related risk factors: age, sex, nursing home residence, ED triage status, dementia, Acute Physiology in Age and Chronic Health Evaluation II physiological score, and RAND comorbidity score. ED crowding risk factors: ED census and mean length of stay. Outcomes: documentation of pain assessment, time to pain assessment, time to pain treatment, patients reporting pain receiving analgesia, and meperidine use.RESULTS: Mean age was 83 (range 52-101), 81.0% of patients complained of pain, mean time to pain assessment was 40 minutes (range 0-600), time to treatment was 141 minutes (range 10-525), and mean delay to treatment was 122 minutes (range 0-526). Of those with pain, 35.9% received no analgesia, 7.0% received nonopioids, and 57.0% received opioids. Of those receiving opioids, 32.8% received meperidine. ED crowding at census levels greater than 120% bed capacity was significantly associated with a lower likelihood of documentation of pain assessment (P=.05) and longer times to pain assessment (P=.01).CONCLUSION: Older adults with hip fracture are at risk for underassessment of pain, considerable delays in analgesic administration after pain is identified, and treatment with inappropriate analgesics (e.g., meperidine) in the ED. Higher levels of ED census are significantly associated with poorer pain management.