1. Toward the Painless Emergency Department Robert W. Strauss, M.D., FACEP ACEP Scientific Assembly San Francisco October 20, 2004

2. Influential Organizations  ED Practice Management Organizations  Academic Organizations  ACGME, SAEM, CORD-EM  ABEM  ACEP

3. 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

4. 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 &…)

5. Administrative “buy-in”

6. 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.”

7. Emergency Medicine Statistical Profile Aug, 2003 (acep.org)

8. Emergency Medicine Statistical Profile Aug, 2003 (acep.org)

9. 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

11. Dramatic increase in utilization Dramatic increase in utilization

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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