Pain Care Management in the Emergency Department: A Retrospective Study to Examine One Program's Effectiveness

Abstract

No clear consensus exists regarding the most appropriate approach to reducing repetitive ED visits for pain complaints. These visits create a burden on health care resources and may contribute to inappropriate and excessive use of opioid medications. The purpose of this study was to examine the pain management program in 1 emergency department (1) to determine whether ED visits significantly decreased among program enrollees; (2) to quantify program interventions applied to enrollees; and (3) to explore relationships between enrollee characteristics (sex, age, comorbidities, health coverage plans) and the program's interventions and outcomes. A retrospective, descriptive, correlational design was used to examine the medical records of 134 patients who were enrolled in a pain care management program during a 1-year period. Study subjects' ED visits were reduced by 77%, from 3,689 total visits during the pre-enrollment year to 852 in the post-enrollment year (P < .001). As a result of the program, patients were referred to primary care providers (58%), addiction specialists (14%), dentists (4%), neurosurgeons (4%), and neurologists (4%). The most common pain management program interventions were narcotic restriction (65%), establishment of a non-narcotic treatment regimen (57%), and enactment of a "1 pharmacy/1 provider" restriction (23%). This study supports existing evidence that patients with an excessive number of ED visits for pain-related complaints can be managed with a proactive pain care management program that includes coordination with a primary care provider and a supportive ED medical staff.