Toward the Painless Emergency Department Robert W Strauss

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 Ø ABEM Ø ACEP

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 greater efficiency Ø Entrepeneurial “market driven” Ø Success requires: Ø Effective provision of services Ø Meeting needs of stakeholders (physicians &…)

Administrative “buy-in”

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)

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

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 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 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 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 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 staff support Ø Notice by members Ø Seat at the council Ø Opportunity to propose / promote resolution Ø Influence committee objectives