The results may not come as a surprise to anyone who’s ever had to visit an ER after an unfortunate accident, but a new University of Colorado study has found that as crowding in hospital emergency rooms significantly decreases the likelihood that children will be administered pain medication for acute bone fractures in a timely manner.
The study, conducted by the University of Colorado School of Medicine and published in the Academic Emergency Medicine journal, found that child patients were up top 47 percent less likely to receive “timely care” when crowding in an emergency room was in the 90th percentile.
The researchers studied the experiences of more than 1,200 patients who were treated by the emergency room staff of an academic children’s hospital for more than a year. The researchers focused on long bone fractures in the arms and legs these are the most common and painful among children.
“Pain associated with long bone fractures can be pretty severe,” said Marion Sills, MD, MPH, who served as the lead author of the study. “But crowded emergency departments are impacting the delivery of care on many levels, including the delivery of pain medication.”
The study is the first one to focus on children after five previous studies that investigated the same impact of crowded emergency room on pain treatment of adults. Those studies found that adults faced a similar lower level of pain treatment in those situations.
“We found that crowding can lower the likelihood of timely treatment by as much as 47 percent and raise the likelihood of non-treatment by as much as 17 percent,” said Sills. “The relationship between emergency department crowding and pain treatment is not unexpected. When the emergency department gets busier, staff may be less responsive to the needs of individual patients, and as a result, patients have a higher likelihood of non-treatment and delays in treatment.”
As for the reasons behind the drop in treatment time, the researchers said there are several to consider. In some ERs, they explained, doctors are the only ones who can OK the use of certain types of pain medication
One possible solution, according to Stills, is for hospitals to hire additional staff to address the issue, although she admits it might be expensive. Hospitals may also wish to investigate the possibility of instituting pain management protocols such as standing orders for nurses to monitor under-treated pain, as well as computer and phone alerts.
In addition, said Stills, hospitals may wish to consider creating incentives for patients to seek emergency care at their own physician’s office as well as implement disincentives for patients who visit emergency rooms for non-emergency situations.
“Crowding is a serious issue for everyone,” said Sills. “It is caused by a variety of things, from patients who too readily use emergency departments to federal policies that exacerbate the problem.
“We as a nation need to get serious about this. Crowding needs to be a policy priority at every level.”