Toward the Painless Toward the Painless Emergency DepartmentEmergency Department

Robert W. Strauss, M.D., FACEPRobert W. Strauss, M.D., FACEPACEP Scientific AssemblyACEP Scientific Assembly

San FranciscoSan FranciscoOctober 20, 2004October 20, 2004

Influential OrganizationsInfluential Organizations

ED Practice Management OrganizationsED Practice Management Organizations Academic Organizations Academic Organizations

ACGME, SAEM, CORD-EMACGME, SAEM, CORD-EM

ABEMABEM ACEPACEP

ObjectivesObjectives

List organizations that could promote pain List organizations that could promote pain

management (PM) as core EM issuemanagement (PM) as core EM issue

Clarify responsibilities and stakeholdersClarify responsibilities and stakeholders

Describe strategies to elevate PM as an Describe strategies to elevate PM as an

essential issue essential issue

PMOsPMOs Efficient way to match need and resources Efficient way to match need and resources

Greater size may create greater efficiencyGreater size may create greater efficiency

Entrepeneurial “market driven”Entrepeneurial “market driven”

Success requires:Success requires: Effective provision of servicesEffective provision of services

Meeting needs of stakeholders (physicians &…)Meeting needs of stakeholders (physicians &…)

Administrative “buy-in”Administrative “buy-in”

ED “Times, they are a changin”ED “Times, they are a changin”

Administrative goals for the EDAdministrative goals for the ED

1988 – No problems or complaints1988 – No problems or complaints 1993 – “As California goes...” Let’s 1993 – “As California goes...” Let’s

downsize the ED. After all, we are going downsize the ED. After all, we are going to see fewer patients.”to see fewer patients.”

0102030405060708090

100110

1993 1997 2001

ED Visits

EDs

Emergency Medicine Statistical ProfileEmergency Medicine Statistical Profile

Aug, 2003 (acep.org)Aug, 2003 (acep.org)

15

17

19

21

23

25

27

29

1993 1997 2001

Pts / ED

Emergency Medicine Statistical ProfileEmergency Medicine Statistical Profile

Aug, 2003 (acep.org)Aug, 2003 (acep.org)

ED “Times, they are a changin”ED “Times, they are a changin”

Administrative goals for the EDAdministrative goals for the ED

1988 – No problems or complaints1988 – No problems or complaints 1993 – “As California goes...” Let’s 1993 – “As California goes...” Let’s

downsizedownsize 1998 – Be nice to the ones who pay:1998 – Be nice to the ones who pay:

and we’ll support youand we’ll support you

0

100

200

300

400

500

1994 1995 1996 1997

P-GSurvey

Dramatic increase in utilizationDramatic increase in utilization

Patient Satisfaction Dependent upon:Patient Satisfaction Dependent upon:

Arrival to physician time (door to Dr.)Arrival to physician time (door to Dr.) Boudreaux AEM(s)10/03 (High acuity more satisfied)Boudreaux AEM(s)10/03 (High acuity more satisfied)

Turn-around-timeTurn-around-time Advisory Board – Patients get care 20% of stay Advisory Board – Patients get care 20% of stay

Caring, comforting and informingCaring, comforting and informing

Patient Satisfaction Dependent upon:Patient Satisfaction Dependent upon:

Arrival to physician time (door to Dr.)Arrival to physician time (door to Dr.) Boudreaux AEM(s)10/03 (High acuity more satisfied)Boudreaux AEM(s)10/03 (High acuity more satisfied)

Turn-around-timeTurn-around-time Advisory Board – Patients get care 20% of stay Advisory Board – Patients get care 20% of stay

Caring, comforting and informingCaring, comforting and informing

Attention to painAttention to pain

PMOs - RecommendationsPMOs - Recommendations Provide effective pain management protocolsProvide effective pain management protocols

Specific approaches to presenting problemsSpecific approaches to presenting problems Usable pain scalesUsable pain scales Rapid use of analgesicsRapid use of analgesics

Collaborate in research protocols Collaborate in research protocols Show relationship between PM and Show relationship between PM and

satisfactionsatisfaction Which PMOs – those using P-GWhich PMOs – those using P-G Incorporate pain reduction in EMRsIncorporate pain reduction in EMRs

RRC – EM ApproachRRC – EM Approach Change program requirements?Change program requirements?

Slow processSlow process Reticence to adding specific requirementReticence to adding specific requirement

Incorporate into the competenciesIncorporate into the competencies Which ones?Which ones? Provide programs with tools they need to Provide programs with tools they need to

demonstrate competencies demonstrate competencies

ABEM - ModelABEM - Model Current lack of focus on PMCurrent lack of focus on PM

All examples relate to pain presentationsAll examples relate to pain presentations Pain only mentioned 9 times in contentPain only mentioned 9 times in content Appendix – Procedures and Skills – “Other”Appendix – Procedures and Skills – “Other”

If a focus is createdIf a focus is created Programs will teach itPrograms will teach it ABEM will test itABEM will test it

Add to the LLSA reading list Add to the LLSA reading list

ACEPACEP Submit education proposalsSubmit education proposals Create a section on Pain ManagementCreate a section on Pain Management

ACEP staff supportACEP staff support Notice by membersNotice by members Seat at the councilSeat at the council Opportunity to propose / promote resolutionOpportunity to propose / promote resolution Influence committee objectivesInfluence committee objectives