Presented at the Society for Academic Emergency Medicine Annual Meeting, New Orleans, LA, May 2009.
The Association between Emergency Department Crowding and Analgesia Administration in Acute Abdominal Pain Patients
Version of Record online: 22 JUN 2009
© 2009 by the Society for Academic Emergency Medicine
Academic Emergency Medicine
Volume 16, Issue 7, pages 603–608, July 2009
How to Cite
Mills, A. M., Shofer, F. S., Chen, E. H., Hollander, J. E. and Pines, J. M. (2009), The Association between Emergency Department Crowding and Analgesia Administration in Acute Abdominal Pain Patients. Academic Emergency Medicine, 16: 603–608. doi: 10.1111/j.1553-2712.2009.00441.x
- Issue online: 1 JUL 2009
- Version of Record online: 22 JUN 2009
- Received November 7, 2008; revisions received February 25 and March 13, 2009; accepted March 23, 2009.
- abdominal pain;
- quality of care;
- emergency department
Objectives: The authors assessed the effect of emergency department (ED) crowding on the nontreatment and delay in treatment for analgesia in patients who had acute abdominal pain.
Methods: This was a secondary analysis of prospectively enrolled nonpregnant adult patients presenting to an urban teaching ED with abdominal pain during a 9-month period. Each patient had four validated crowding measures assigned at triage. Main outcomes were the administration of and delays in time to analgesia. A delay was defined as waiting more than 1 hour for analgesia. Relative risk (RR) regression was used to test the effects of crowding on outcomes.
Results: A total of 976 abdominal pain patients (mean [±standard deviation] age = 41 [±16.6] years; 65% female, 62% black) were enrolled, of whom 649 (67%) received any analgesia. Of those treated, 457 (70%) experienced a delay in analgesia from triage, and 320 (49%) experienced a delay in analgesia after room placement. After adjusting for possible confounders of the ED administration of analgesia (age, sex, race, triage class, severe pain, final diagnosis of either abdominal pain not otherwise specified or gastroenteritis), increasing delays in time to analgesia from triage were independently associated with all four crowding measures, comparing the lowest to the highest quartile of crowding (total patient-care hours RR = 1.54, 95% confidence interval [CI] = 1.32 to 1.80; occupancy rate RR = 1.64, 95% CI = 1.42 to 1.91; inpatient number RR = 1.57, 95% CI = 1.36 to 1.81; and waiting room number RR = 1.53, 95% CI = 1.31 to 1.77). Crowding measures were not associated with the failure to treat with analgesia.
Conclusions: Emergency department crowding is associated with delays in analgesic treatment from the time of triage in patients presenting with acute abdominal pain.