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Toward the Painless Emergency Department. Robert W. Strauss, M.D., FACEP ACEP Scientific Assembly San Francisco October 20, 2004. Influential Organizations. ED Practice Management Organizations Academic Organizations ACGME, SAEM, CORD-EM ABEM ACEP. Objectives.

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toward the painless emergency department

Toward the Painless Emergency Department

Robert W. Strauss, M.D., FACEP

ACEP Scientific Assembly

San Francisco

October 20, 2004

influential organizations
Influential Organizations
  • ED Practice Management Organizations
  • Academic Organizations
    • ACGME, SAEM, CORD-EM
  • ABEM
  • ACEP
objectives
Objectives
  • List organizations that could promote pain management (PM) as core EM issue
  • Clarify responsibilities and stakeholders
  • Describe strategies to elevate PM as an essential issue
slide4
PMOs
  • Efficient way to match need and resources
  • Greater size may create greater efficiency
  • Entrepeneurial “market driven”
  • Success requires:
    • Effective provision of services
    • Meeting needs of stakeholders (physicians &…)
ed times they are a changin
ED “Times, they are a changin”

Administrative goals for the ED

  • 1988 – No problems or complaints
  • 1993 – “As California goes...” Let’s downsize the ED. After all, we are going to see fewer patients.”
ed times they are a changin9
ED “Times, they are a changin”

Administrative goals for the ED

  • 1988 – No problems or complaints
  • 1993 – “As California goes...” Let’s downsize
  • 1998 – Be nice to the ones who pay:

and we’ll support you

patient satisfaction dependent upon
Patient Satisfaction Dependent upon:
  • Arrival to physician time (door to Dr.)
    • Boudreaux AEM(s)10/03 (High acuity more satisfied)
  • Turn-around-time
    • Advisory Board – Patients get care 20% of stay
  • Caring, comforting and informing
patient satisfaction dependent upon13
Patient Satisfaction Dependent upon:
  • Arrival to physician time (door to Dr.)
    • Boudreaux AEM(s)10/03 (High acuity more satisfied)
  • Turn-around-time
    • Advisory Board – Patients get care 20% of stay
  • Caring, comforting and informing
  • Attention to pain
pmos recommendations
PMOs - Recommendations
  • Provide effective pain management protocols
    • Specific approaches to presenting problems
    • Usable pain scales
    • Rapid use of analgesics
  • Collaborate in research protocols
  • Show relationship between PM and satisfaction
  • Which PMOs – those using P-G
  • Incorporate pain reduction in EMRs
rrc em approach
RRC – EM Approach
  • Change program requirements?
    • Slow process
    • Reticence to adding specific requirement
  • Incorporate into the competencies
    • Which ones?
    • Provide programs with tools they need to demonstrate competencies
abem model
ABEM - Model
  • Current lack of focus on PM
    • All examples relate to pain presentations
    • Pain only mentioned 9 times in content
    • Appendix – Procedures and Skills – “Other”
  • If a focus is created
    • Programs will teach it
    • ABEM will test it
  • Add to the LLSA reading list
slide17
ACEP
  • Submit education proposals
  • Create a section on Pain Management
    • ACEP staff support
    • Notice by members
    • Seat at the council
    • Opportunity to propose / promote resolution
    • Influence committee objectives