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Toward the Painless Emergency Department Robert W. Strauss, M. D. , FACEP Scientific Assembly Toward the Painless Emergency Department Robert W. Strauss, M. D. , FACEP Scientific Assembly San Francisco October 20, 2004

Influential Organizations Ø ED Practice Management Organizations Ø Academic Organizations Ø ACGME, SAEM, CORD-EM Influential Organizations Ø ED Practice Management Organizations Ø Academic Organizations Ø ACGME, SAEM, CORD-EM Ø ABEM Ø ACEP

Objectives Ø Ø Ø List organizations that could promote pain management (PM) as core Objectives Ø Ø Ø List organizations that could promote pain management (PM) as core EM issue Clarify responsibilities and stakeholders Describe strategies to elevate PM as an essential issue

PMOs Ø Efficient way to match need and resources Ø Greater size may create PMOs Ø Efficient way to match need and resources Ø Greater size may create greater efficiency Ø Entrepeneurial “market driven” Ø Success requires: Ø Effective provision of services Ø Meeting needs of stakeholders (physicians &…)

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

ED “Times, they are a changin” Administrative goals for the ED Ø 1988 – ED “Times, they are a changin” Administrative goals for the ED Ø 1988 – No problems or complaints Ø 1993 – “As California goes. . . ” Let’s downsize the ED. After all, we are going to see fewer patients. ”

Emergency Medicine Statistical Profile Aug, 2003 (acep. org) Emergency Medicine Statistical Profile Aug, 2003 (acep. org)

Emergency Medicine Statistical Profile Aug, 2003 (acep. org) Emergency Medicine Statistical Profile Aug, 2003 (acep. org)

ED “Times, they are a changin” Administrative goals for the ED Ø 1988 – ED “Times, they are a changin” Administrative goals for the ED Ø 1988 – No problems or complaints Ø 1993 – “As California goes. . . ” Let’s downsize Ø 1998 – Be nice to the ones who pay: and we’ll support you

Dramatic increase in utilization Dramatic increase in utilization

Patient Satisfaction Dependent upon: Ø Arrival to physician time (door to Dr. ) Ø Patient Satisfaction Dependent upon: Ø Arrival to physician time (door to Dr. ) Ø Boudreaux AEM(s)10/03 (High acuity more satisfied) Ø Turn-around-time Ø Advisory Board – Patients get care 20% of stay Ø Caring, comforting and informing

Patient Satisfaction Dependent upon: Ø Arrival to physician time (door to Dr. ) Ø Patient Satisfaction Dependent upon: Ø Arrival to physician time (door to Dr. ) Ø Boudreaux AEM(s)10/03 (High acuity more satisfied) Ø Turn-around-time Ø Advisory Board – Patients get care 20% of stay Ø Caring, comforting and informing Ø Attention to pain

PMOs - Recommendations Ø Provide effective pain management protocols Ø Specific approaches to presenting PMOs - Recommendations Ø Provide effective pain management protocols Ø Specific approaches to presenting problems Ø Usable pain scales Ø Rapid use of analgesics Ø Ø Collaborate in research protocols Show relationship between PM and satisfaction Which PMOs – those using P-G Incorporate pain reduction in EMRs

RRC – EM Approach Ø Change program requirements? Ø Slow process Ø Reticence to RRC – EM Approach Ø Change program requirements? Ø Slow process Ø Reticence to adding specific requirement Ø Incorporate into the competencies Ø Which ones? Ø Provide programs with tools they need to demonstrate competencies

ABEM - Model Ø Current lack of focus on PM Ø All examples relate ABEM - Model Ø Current lack of focus on PM Ø All examples relate to pain presentations Ø Pain only mentioned 9 times in content Ø Appendix – Procedures and Skills – “Other” Ø If a focus is created Ø Programs will teach it Ø ABEM will test it Ø Add to the LLSA reading list

ACEP Ø Ø Submit education proposals Create a section on Pain Management Ø ACEP ACEP Ø Ø Submit education proposals Create a section on Pain Management Ø ACEP staff support Ø Notice by members Ø Seat at the council Ø Opportunity to propose / promote resolution Ø Influence committee objectives