Annals of emergency medicine journal club
Pines JM, Hollander JE Emergency Department Crowding is Associated with Poor Care for Patients with Severe Pain

https://doi.org/10.1016/j.annemergmed.2007.11.022Get rights and content

Editor’s Capsule Summary

What is already known on this topic

Emergency department (ED) crowding may result in delays in the administration of medication such as antibiotics for pneumonia.

What question this study addressed

Does crowding cause delays in treatment for pain?

What this study adds to our knowledge

In this retrospective analysis of 13,578 patients treated at a single inner-city ED, patients with severe pain were slightly less likely to receive pain medications quickly when the ED volume increased.

How this might change clinical practice

Crowding may delay the administration of pain medication in some patients. Standing orders for the administration of pain medication might mitigate such delays.

Section snippets

Discussion points

  • 1

    The authors performed a retrospective cohort study of all patients with severe pain presenting to their emergency department (ED). Why do you think the authors chose this type of study design? Describe the strengths and weaknesses of this design and contrast these with those of a prospective cohort study. If you were replicating this study prospectively, how might you alter the study design with respect to: a) the assessment of severity of patient pain; b) receipt of pain medication in the ED;

References (0)

Cited by (13)

  • Development of a Hospital Standardized Mortality Ratio for Emergency Department Care

    2016, Annals of Emergency Medicine
    Citation Excerpt :

    For decades, crowding and access block in the emergency department (ED) have posed major threats to quality and safety of care.1-4

  • Supplemented Triage and Rapid Treatment (START) improves performance measures in the Emergency Department

    2012, Journal of Emergency Medicine
    Citation Excerpt :

    Multiple studies, recently reviewed by Bernstein et al., have demonstrated the negative effect of hospital and ED crowding on a wide variety of ED patient care metrics, including delayed care and increasing numbers of patients who leave the ED without complete assessment (3–17). In addition, and perhaps most importantly, there is mounting evidence that ED crowding adversely affects patient care outcomes, including mortality, thus threatening the very mission of the ED (3,4,9,10,13,14,18–20). As part of their 2006 report detailing these challenges (Hospital-Based Emergency Care: At the Breaking Point), the Institute of Medicine called for improved operations management tools to be employed as part of the solution (1).

  • The impact of emergency department overcrowding on resident education

    2012, Journal of Emergency Medicine
    Citation Excerpt :

    However, overcrowding is most severe in academic centers and urban hospitals, many of which support EM residency training programs (1–3). Several studies have demonstrated that ED overcrowding is associated with increased morbidity and mortality (4–13). However, the impact of ED overcrowding on EM resident education is largely unknown.

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SEE RELATED ARTICLE, P. 1.

Editor’s Note: You are reading the first installment of Annals of Emergency Medicine Journal Club. This bi-monthly feature seeks to improve the critical appraisal skills of emergency physicians and other interested readers through a guided critique of actual Annals of Emergency Medicine articles. Each Journal Club will pose questions that encourage readers - be they clinicians, academics, residents, or medical students - to critically appraise the literature.

Over a two- to three-year cycle we plan to ask questions that cover the main topics in research methodology and critical appraisal of the literature. To do this we will select articles that use a variety of study designs and analytic techniques. These may or may not be the most clinically important articles in a specific issue but they are articles that serve the mission of covering the clinical epidemiology curriculum.

Journal Club entries will be published in two phases. In the first phase, a list of questions about the article will be published in the issue that the article appears. Questions are rated “novice,” (

) “intermediate,” (
) “advanced” (
), so that individuals planning a journal club can assign the right question to the right student. The second phase consists of the publication of suggested answers. This will be done 5 months following the publication of the questions. However, residency directors will have immediate access to the answers through the Council of Emergency Medicine Residency Directors Share Point Web site. Thus, if an actual journal club is conducted within 5 months of the publication of the questions, no one will have access to the published answers except the residency director. The purpose of delaying the publication of the answers is to promote discussion and critical review of the literature by both residents and medical students and discourage regurgitation of the published answers.

It is our hope that the Journal Club will broaden Annals of Emergency Medicine’s appeal to residents and medical students. We are interested in receiving feedback about this feature. Please e-mail [email protected] with your comments.

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