One of the new CMS quality measures involves measuring time to receipt of pain medication for patients diagnosed with long bone fractures. While this isn’t the most exciting quality measure in terms of outcomes, it is probably a reasonable expectation that fractures receive pain control, and it might be a plausible surrogate marker for overall Emergency Department operations – at least, until the powers that be focus solely on these few measures at the expense of other clinical operations.
This article is a retrospective review of all pediatric long bone fractures evaluated at their facility. They used the electronic medical record to track the timing of any “adequate” pain medication. They have a specific weight-based definition of “adequate” for IV narcotics, PO narcotics, and non-narcotic analgesics, and they specifically break down pain medication received within 1 hour of arrival.
They identified 773 cases in their records, and by their definitions, 75 patients received an “adequate” dose of pain medication within 1 hour. One can quibble with their definition of “adequate” because there is a range of pain needs that don’t necessarily require maximal dosing. But, you cannot quibble with the fact that 353 children received no pain medication at all within an hour of ED arrival (or prior to ED arrival). Certainly, some individual factors at play would result in reasonable delays to pain medication, but definitely not nearly half.
“Analgesic Administration in the Emergency Department for Children Requiring Hospitalization for Long-Bone Fracture”
http://www.ncbi.nlm.nih.gov/pubmed/22270501