Discordance between patient-reported and actual emergency department pain management

David McD Taylor; Safire Valentine; James Majer; Nicole Grant

doi:10.1111/1742-6723.13690

Discordance between patient-reported and actual emergency department pain management

Emerg Med Australas. 2021 Jun;33(3):517-523. doi: 10.1111/1742-6723.13690. Epub 2020 Nov 22.

Authors

David McD Taylor^{1

2}, Safire Valentine³, James Majer⁴, Nicole Grant⁵

Affiliations

¹ Department of Emergency Medicine, Austin Hospital, Melbourne, Victoria, Australia.
² Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
³ Box Hill Hospital, Melbourne, Victoria, Australia.
⁴ Barwon Health, Geelong, Victoria, Australia.
⁵ Western Health, Melbourne, Victoria, Australia.

PMID: 33225600
DOI: 10.1111/1742-6723.13690

Abstract

Objective: To determine patient knowledge of the nature of their pain management in the ED.

Methods: This was a planned sub-study of data collected during a randomised, controlled trial of the nature of the informed consent process in a single ED. Patients aged ≥18 years, with a triage pain score of ≥4, were enrolled. Forty-eight hours post-ED discharge, patients were asked if they had declined analgesia or if a range of pain management options had been administered. The primary outcome was discordance between the patient report and the ED report (proportion of cases where these reports differed).

Results: Outcome data were collected on 655 patients. There was significant discordance for all variables examined (P < 0.001). Discordance for patients declining analgesia was lowest at 8.9% (95% confidence interval [CI] 6.8-11.4). Discordance for administration of pain management 'other' than analgesia was highest at 32.6% (95% CI 29.0-36.4). Discordance for the administration of oral analgesia or 'any' analgesia was 17.1% (95% CI 14.3-20.3) and 14.4% (95% CI 11.8-17.3), respectively. For both of these outcomes, patients with chest pain and lower triage pain scores were more likely to report discordant responses. With the exception of 'other' pain management, smaller proportions of patients incorrectly reported not receiving management than incorrectly reporting that they did receive it.

Conclusion: Patients are often unaware of the nature of their pain management. They are most often unaware of management other than analgesia. Patients with chest pain and lower triage pain scores had the least knowledge of their pain management.

Keywords: emergency department; knowledge; pain.