ER crowding delays pain treatment for hip fracture

NEW YORK (Reuters Health) - Crowding in the emergency department (ED) negatively affects the management of pain elderly patients who have fractured a hip, the results of a study published in the Journal of the American Geriatrics Society indicate.

Dr. Ula Hwang, of Mount Sinai School of Medicine, New York, and colleagues conducted a review of ED records from a study that included 158 patients 50 years of age or older with a hip fracture.

Hwang's group evaluated records of pain assessment, time to pain assessment, administration of pain medication and type of analgesic. They also noted the ED activity during the hour the hip fracture patient arrived based on the hospital's admission, discharge and transfer data.

The average age of the hip fracture patient was 83 years. Overall, 128 patients (81 percent) complained of pain and 115 (72.8 percent) underwent a pain assessment. The average time to pain assessment and treatment was 40 minutes and 141 minutes, respectively. The average delay in receiving treatment was 122 minutes.

Of the patients who reported pain, 36 percent received no analgesic, 7 percent received non-opioid drugs and 57 percent received opioid drugs.

Fifty patients encountered crowded ED conditions. When the ED was at more than 120-percent of bed capacity, the researchers noted a statistically significantly lower probability of having their pain assessed compared with when the ED was at 120-percent bed capacity or less.

Hwang's group also found that ED levels greater than 120-percent bed capacity were significantly associated with a longer time before pain level was assessed.

The investigators conclude that these findings show that ED crowding adversely affects quality of care. Even though the study was conducted at one institution, the results probably indicate a general "need for a better understanding of current and future ED pain-management guidelines."

SOURCE: Journal of the American Geriatrics Society, February 2006.