The experience of care of patients presenting in pain to the Emergency Department

Mr James Hughes1, Prof Patsy Yates2, A/Prof Kim Alexander2, Dr Lyndall Spencer3

1Royal Brisbane & Women’s Hospital / Queensland University Of Technology, Herston, Australia, 2School of Nursing, Queensland University of Technology, Kelvin Grove , Australia, 3Princess Alexandra Hospital, Woolloongabba, Australia

Introduction: Pain is the most common symptom reported by people presenting to the emergency department (ED) with up to 65% of all presentations involving a painful symptom. Despite its high prevalence, pain continues to be undertreated within the ED. Pain is a subjective symptom, therefore it is best described by the patient. However the experience of patients who present to the ED in pain is rarely explored.
Aim:   To identify the person, environment, health and illness factors that influence the experience of care of patients presenting to the adult ED in moderate to severe pain.
Methods: A prospective observational study of patients presenting to a large inner-city adult emergency department using a previously validated measure of five components of patient experience. This study was conducted between November 2016 and April 2017. Multivariable modelling was used to identify the factors that influenced patient experience. The study was based on Symptom Management Theory.
Results: All domains of nursing science (Person, Environment, Health, and Illness) were represented as having influence over different aspects of patient’s experience measured in this study. When patients were asked to report on their overall experience of care; patient waiting time (B-0.008, 95%CI -0.120, -0.005, p<0.001) and patient age (B0.015, 95%CI 0.003, 0.027, p=0.012) formed a significant model, but explained just 11% of the variance. For patients who received analgesic medication, the time to first analgesic medication influenced overall patient experience (B-0.005, 95%CI -0.007, -0.002, p<0.001) explaining 7.5% of the variance seen in the experience of care (adjusted r2 0.075).
Conclusion:  The patient experience of care in the emergency department is complex and influenced by different factors, including the timely provision of analgesic medication and the workload of the ED.


Biography:

Mr Hughes is the Nurse Research Manager at the Emergency and Trauma Centre, Royal Brisbane and Women’s Hospital. This is a jointly appointed position Queensland University of Technology and partly funded through the Emergency Medicine Foundation. His research interests include pain management in the ED, patient flow and capacity building in emergency research. He is currently finishing off his PhD in pain care at QUT.