ABSTRACT
Background: In every Emergency Department (ED), pain is among one of the most common complaints of patients. There are many evidences shown that, despite the increasing of concern for pain management, it is still undertreated. Emergency medicine in Thailand is in its developing stage and in the past there was very little concern about proper pain management in ED. Pain score was not routinely used and with many different incomparable methods. Objective: To study quality and efficiency of pain management process in emergency room Ramathibodi hospital and introduce pain score as a pain assessment instrument in emergency room setting of Ramathibodi hospital. Method: A cross-sectional study was performed between November to December 2006. Patients who were older than 15 years old, able to communicate and presented at ER with any kind of pain were enrolled. Numerical rating scale (NRS-11) was applied first at arrival and again before discharge from ED. Aside from pain score we also collected data on chief complaints, arrival time, time to analgesics given, type and root of analgesics given and demographic data of the patients. Results: 259 medical records were reviewed, only 147 records are completed for analysis. Overall mean pain score improvement is 4.02 (p \< 0.001). In patients who receive analgesics mean pain score improvement is 4.86 (SD = 2.956, 95% CI = 4.26-5.43) compare to 1.93 (P \< 0.001, 95% CI = 1.11-2.750) in non-treatment group. 105 patients receive analgesic, 6 were exclude due to missing time of analgesic given, mean time to analgesic given is 56.1 minutes (3-260, SD = 42). In severe pain group takes the longest mean time to analgesic given, which is 59.3 minutes (3-260, SD = 49). Discussion: Overall, there is statistically and clinically significant decrease in pain score. The pain score improvement is obviously different between treatment and non-treatment group. In term of waiting time for pain relief, patients have to wait for a long time to receive analgesics. Patients in severe pain group wait longer and even worse, some patients did not receive treatment at all. This may be implied to the lacking of concern about pain problems in our emergency department. Conclusion: This study revealed problems in many aspects regarding pain management system in our ED. In term of quality improvement, more comprehensive studies are required. Pain score, as a pain assessment instrument, is essential for both further research and quality improvement program.