Annals of Emergency Medicine
Volume 51, Issue 1 , Pages 1-5, January 2008

Emergency Department Crowding Is Associated With Poor Care for Patients With Severe Pain

Presented at the Society for Academic Emergency Medicine National Assembly, May 2007, Chicago, IL.

  • Jesse M. Pines, MD, MBA, MSCE

      Affiliations

    • Department of Emergency Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA
    • Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, and the Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA.
    • Corresponding Author InformationAddress for correspondence: Jesse M. Pines, MD, MBA, 3400 Spruce Street, Ground Ravdin, Philadelphia, PA 19104; 215-662-4050, fax 215-662-3953
    • ,
  • Judd E. Hollander, MD

      Affiliations

    • Department of Emergency Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA

Received 24 April 2007; received in revised form 31 May 2007 and 21 June 2007; accepted 5 July 2007. published online 03 October 2007.

Study objective

We study the impact of emergency department (ED) crowding on delays in treatment and nontreatment for patients with severe pain.

Methods

We performed a retrospective cohort study of all patients presenting with severe pain to an inner-city, teaching ED during 17 months. Poor care was defined by 3 outcomes: not receiving treatment with pain medication while in the ED, a delay (>1 hour) from triage to first pain medication, and a delay (>1 hour) from room placement to first pain medication. Three validated crowding measures were assigned to each patient at triage. Logistic regression was used to test the association between crowding and outcomes.

Results

In 13,758 patients with severe pain, the mean age was 39 years (SD 16 years), 73% were black, and 64% were female patients. Half (49%) of the patients received pain medication. Of those treated, 3,965 (59%) experienced delays in treatment from triage and 1,319 (20%) experienced delays from time of room placement. After controlling for factors associated with the ED treatment of pain (race, sex, severity, and older age), nontreatment was independently associated with waiting room number (odds ratio [OR] 1.03 for each additional waiting patient; 95% confidence interval [CI] 1.02 to 1.03) and occupancy rate (OR 1.01 for each 10% increase in occupancy; 95% CI 0.99 to 1.04). Increasing waiting room number and occupancy rate also independently predicted delays in pain medication from triage (OR 1.05 for each waiting patient, 95% CI 1.04 to 1.06; OR 1.18 for each 10% increase in occupancy; 95% CI 1.15 to 1.21) and delay in pain medication from room placement (OR 1.02 for each waiting patient, 95% CI 1.01 to 1.03; OR 1.06 for each 10% increase in occupancy, 95% CI 1.04 to 1.08).

Conclusion

ED crowding is associated with poor quality of care in patients with severe pain, with respect to total lack of treatment and delay until treatment.

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 Supervising editors: Debra E. Houry, MD, MPH; Michael L. Callaham, MD.

 Author contributions: JMP was responsible for data collection and article preparation. JMP and JEH were responsible for study design, data analysis, and final article preparation. JEH was responsible for study supervision. JMP had full access to the data in this study and was responsible for the integrity of the data and the accuracy of the data analysis. JMP takes responsibility for the paper as a whole.

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that may create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. Jesse M. Pines, MD, MBA, is supported by the 2006-7 Riggs Family/Health Policy Grant from the American College of Emergency Physicians.

 Reprints not available from the authors.

 Publication dates: Available online October 25, 2007.

PII: S0196-0644(07)01297-8

doi:10.1016/j.annemergmed.2007.07.008

Refers to article:

  • Pines JM, Hollander JE Emergency Department Crowding is Associated with Poor Care for Patients with Severe Pain

    Tyler W. Barrett, David L. Schriger
    Annals of Emergency Medicine January 2008 (Vol. 51, Issue 1, Pages 6-7)

Annals of Emergency Medicine
Volume 51, Issue 1 , Pages 1-5, January 2008

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