Problems and barriers of pain management in the emergency department: Are we ever going to get better?

From the Journal of Pain Research:

Abstract: Pain is the most common reason people visit emergency rooms. Pain does not discriminate on the basis of gender, race or age. The state of pain management in the emergency department (ED) is disturbing. ED physicians often do not provide adequate analgesia to their patients, do not meet patients’ expectations in treating their pain, and struggle to change their practice regarding analgesia. A review of multiple publications has identified the following causes of poor management of painful conditions in the ED: failure to acknowledge pain, failure to assess initial pain, failure to have pain management guidelines in ED, failure to document pain and to assess treatment adequacy, and failure to meet patient’s expectations. The barriers that preclude emergency physicians from proper pain management include ethnic and racial bias, gender bias, age bias, inadequate knowledge and formal training in acute pain management, opiophobia, the ED, and the ED culture. ED physicians must realize that pain is a true emergency and treat it as such.

Emergency Medical Services-Based Community Stroke Education

From the American Heart Association:

Background and Purpose—Although previous studies using mass media have demonstrated successful public stroke awareness campaigns, they may have been too costly for smaller communities to implement. The goal of this study was to investigate if a novel emergency medical services (EMS) -sponsored community awareness campaign could increase public stroke awareness.

Methods—This was a pre- and postintervention study with 2 phases conducted between August 2005 and July 2007. During Phase I, strategic placement of stroke education media by EMS personnel was implemented in one county over a 2-year period. Five random-digit, standardized phone surveys measuring stroke awareness were conducted with county residents to assess the campaign’s impact. In Phase II, EMS interventions and random-digit measurements were conducted in 4 additional counties with 4 counties randomly selected as controls.

Results—A pattern of increasing stroke knowledge after exposure to the EMS intervention followed by declines in the absence of the intervention was observed during Phase I. EMS interventions also demonstrated a positive effect on the stroke knowledge of residents who lived in counties exposed to the intervention during Phase II with a statistically significant (P<0.05) increase observed in the proportion of respondents that named 2 stroke risk factors and 3 symptoms in comparison to either no changes or declines in the control counties. No evidence of a positive impact on knowledge of calling 911 for stroke was observed.

Conclusion—Results of this study suggest that the public’s knowledge of stroke signs and symptoms was increased using communitywide EMS-based programs. Additional studies are needed to determine optimal methods for educating the public regarding the need to call 911 for stroke and to confirm these results in other locales.

Weekend Emergency Department Visits in Nebraska: Higher Utilization, Lower Acuity

From ScienceDirect:


Background: We know very little about differences in Emergency Department (ED) utilization and acuity on weekends compared with weekdays. Understanding such differences may help elucidate the role of the ED in the health care delivery system.

Study Objective: To compare patterns of ED use on weekends with weekdays and analyze the differences between these two groups.

Methods: The Health Care Utilization Project (HCUP) is a national state-by-state billing database from acute-care, non-federal hospitals. Data from Nebraska in 2004 was used to compare ED-only patient visits (patients discharged home or transferred to another health care facility) and ED-admitted visits (patients admitted to the same hospital after an ED visit) for weekend vs. weekday frequency, billed charges, sex, age, and primary payer.

Results: Of all non-admitted patients who visited the ED, 34.5% came in on weekends. This yielded ED utilization rates of 25 visits/1000 people on weekdays and 33 visits/1000 people on weekends, an increase of 32% on weekends. Weekend-only ED patients of all ages and payer categories were charged lower hospital facility fees than weekday-only ED patients; $777 vs. $921, respectively (p < 0.001). Weekend ED patients were less likely to be admitted and less likely to die while in the ED (2 deaths/1000 ED visits for weekend-only patients vs. 3 deaths/1000 ED visits for weekday-only [p < 0.001]).

Conclusions: In Nebraska, EDs care for a greater number of low-acuity patients on weekends than on weekdays. This highlights the important role EDs play within the ambulatory care delivery system.

But is it really an emergency? When to take a child to the ER

From the CNN “Empowered Patient” series:

Dr. Assaad Sayah, chief of emergency medicine for the Cambridge Health Alliance in Massachusetts, agrees that parents should use their instincts when deciding whether their child needs quick medical attention.

” ‘When in doubt, bring them in’ should be your first line of defense,” he said. “If they don’t look right to you, call your pediatrician, or take them to the emergency department, and if they look very sick, call 911.”

Although relying on instinct is a good guideline, there are also some cut-and-dry situations when a parent really should to take a child to the ER. Here are five examples.

1. Neck stiffness or rash with fever

According to the American College of Emergency Physicians, these symptoms could constitute an emergency because they might mean meningitis.

(more on the site)

Sleep, shower and steal

From the Orange County Register:

A Fountain Valley doctor can no longer practice medicine after sneaking into hospitals where he did not work to sleep, shower and steal medical supplies to sell on eBay, according to state medical records.

The California Medical Board revoked the license of Dr. Roy Chi Wing Lung, who practiced emergency medicine, effective this week. A woman who answered the phone Tuesday at Lung’s Mission Viejo home hung up. Lung’s lawyer, Michael Khouri, said Lung can reapply for his license in three years.

“He’s a good physician but he made some errors in judgment,” Khouri said. “Unfortunately, when you’re in that position, you can’t make those kind of errors.”

The legal documents allege the following:

In 2004, Lung, 42, pleaded no contest to burglary and theft in connection with taking two computers from Long Beach Memorial Medical Center. He was accused of showing up in blue scrubs and a white doctor’s coat to blend in, although he was not a member of the staff. He was ordered to pay $5,000 in restitution.

In 2007 and 2008, the medical board documents say that Lung was spotted at Orange Coast Memorial Medical Center in Fountain Valley, where he did not have medical privileges. He worked at a hospital in Huntington Park. On one occasion at Orange Coast, he was caught in the doctor’s lounge with a tray of food, working on a hospital computer. He refused to identify himself and the hospital called police.

Wing allegedly told officers that he had used the hospital about once a week for 10 years when he was tired on his way home. When police searched his car, they found three boxes of sutures packaged for shipment. Police tracked the address and discovered that Wing was selling sutures on eBay for $50 a box. He denied stealing them from the hospital, though a nurse had reported seeing him with full pockets, the documents say.

Consumers see hospital price growth ease in March

From Modern Healthcare:

Consumer prices for hospital services rose 0.6% in March compared with 0.9% in February and 0.8% in January, according to the Bureau of Labor Statistics’ seasonally adjusted Consumer Price Index. In March 2008, consumer prices for hospitals rose 0.3%. For the 12-month period ended last month, the hospital CPI increased 6.5% compared with 8.3% in the year-ago period.

The CPI for physician services prices grew 0.2% last month after remaining flat in February and a 0.2% increase in January. For March 2008, the physician services CPI edged up 0.1%. In 12-month period ended last month, consumer prices for physician services rose 3.4% compared with 2.2% in the previous year.