Hospital Crowding Reduces Pain Care for Children
Crowded emergency rooms are less effective in treating children in pain, according to a study on Thursday.
Researchers from the University Of Colorado School Of Medicine examined the use of pain medication in hospital emergency departments for children suffering acute long bone fractures, and found that crowding has led to a decrease in the timely and effective delivery of pain medication.
“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 Marion Sills, the lead author of the study in a statement. “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.”
The study found that patients were 4 to 47 percent less likely to receive timely treatment, and 3 to 7 percent were less likely to receive effective treatment when crowding was at 90 percent capacity compared to when emergency departments were 10 percent occupied.
Researchers focused on long bone fractures, like broken arms or broken legs, because they are common among children, and also very painful.
“Pain associated with long bone fractures can be pretty severe,” said Sills. “But crowded emergency departments are impacting the delivery of care on many levels, including the delivery of pain medication.”
Previous studies showed that crowded emergency rooms lead to the decrease in pain control for adults, but the current study is the first to evaluate the impact of crowding on children with fracture-related pain.
Many factors contribute to hospital crowding, Sills said.
Some hospitals only allow doctors to administer pain medication, whereas other hospitals allow nurses to give analgesia to patients who meet certain conditions.
Hospitals should hire more staff, or better leverage the staff they have, Sills said. She added that hospitals should tackle pain managements with standing orders for nurses, and computer or phone based alerts that call attention to under-treated pain.
Seeking care from primary doctors is also a good way to combat hospital crowding, patients should be offered compensation for seeking primary care over emergency departments, she said.
“Crowding is a serious issue for everyone. It is caused by a variety of things, from patients who too readily use emergency departments to federal policies that exacerbate the problem,” Sills said. “We as a nation need to get serious about this. Crowding needs to be a policy priority at every level.”