The influence of chief complaint on opioid use in the emergency department

Kathleen Puntillo, RN, DNSc, FAAN; Martha Neighbor, MD; Garrett K. Chan, APRN, BC, PhD; Roxanne Garbez, RN, MS, ACNP

doi:10.5055/jom.2006.0035

Authors

Kathleen Puntillo, RN, DNSc, FAAN
Martha Neighbor, MD
Garrett K. Chan, APRN, BC, PhD
Roxanne Garbez, RN, MS, ACNP

DOI:

https://doi.org/10.5055/jom.2006.0035

Keywords:

pain, pain assessment, pain treatment, emergency department, decision making, opioids

Abstract

The aim of this study was to explore factors influencing emergency department (ED) clinicians’ use of opioids in treating selected patients. Patients who either received or did not receive opioids in the ED, as well as their nurses and physicians, were interviewed before patient discharge. We found that the decrease in patients’ mean (SD) pain intensity from the time of admission to the ED (7.3 ± 2.4 on a 0 to 10 numeric rating scale) to discharge (5.0 ± 2.9) was statistically significant (t93 = 8.4, p < 0.001, 95 percent CI = 1.7, 2.8) for all groups except those with trauma-related pain. The factor that most frequently led physicians of patients with abdominal pain and nurses in general to administer no opioids was that the patient was “not in that much pain.” However, the patients in question had self-reported pain scores that indicated moderate pain. Our findings lead us to conclude that clinicians inaccurately infer severity of patient pain. This in turn can influence the prescription of opioids and the patient’s decrease in pain.

Author Biographies

Kathleen Puntillo, RN, DNSc, FAAN

University of California, San Francisco School of Nursing, San Francisco, California.

Martha Neighbor, MD

University of California School of Medicine; Department of Medicine, San Francisco General Hospital Emergency Services, San Francisco, California.

Garrett K. Chan, APRN, BC, PhD

University of California, San Francisco School of Nursing, San Francisco, California.

Roxanne Garbez, RN, MS, ACNP

University of California, San Francisco School of Nursing’ San Francisco, California.

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