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Publisher: BMJ
Languages: English
Types: Article
Subjects: RT, R1
Background \ud Provision of prompt, effective analgesia is rightly considered as a standard of care in the emergency department (ED). However, much suffering is not ‘painful’ and may be under-recognised. We sought to describe the burden of suffering in the ED and explore how this may be best addressed from a patient centred perspective.\ud \ud Methods \ud In a prospective cohort study, we included undifferentiated patients presenting to the ED. We undertook two face to face questionnaires with the first immediately following triage. We asked patients: (a) if they were ‘suffering’; (b) how they were suffering; and (c) what they hoped would be done to ease this. Prior to leaving the ED, we asked patients what had been done to ease their suffering. Data were analysed thematically.\ud \ud Results \ud Of 125 patients included, 77 (61.6%) reported suffering on direct questioning and 92 (73.6%) listed at least one way in which they were suffering. 90 (72.0%) patients had a pain score >0/10 but only 37 (29.6%) reported that pain was causing suffering. Patients reported suffering from both physical symptoms (especially pain, nausea, vomiting and dizziness) and emotional distress (notably anxiety). Treatment (to ease physical and emotional symptoms), information (particularly diagnosis, reassurance and explanation), care (notably friendly staff) and closure (being seen, resolving the problem and going home) were the key themes identified as important for relief of suffering.\ud \ud Conclusions \ud In seeking to ease suffering in the ED, clinicians must focus not only on providing analgesia but on treating Emotional distress, Physical symptoms, providing Information, Care and Closure (EPICC).
  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • 5.   Department of Veterans Affairs. Pain as the 5th vital sign toolkit [Internet]. Geriatrics and  Extended Care Strategic Healthcare Group; 2000 [accessed 2013 Apr 2]. Available from:  http://www1.va.gov/painmanagement/docs/toolkit.pdf  1.   Karwowski‐Soulie F, Lessenot‐Tcherny S, Lamarche‐Vadel A, et al. Pain in an emergency  department: an audit. European Journal of Emergency Medicine 2006; 13: 218-24.   7.   Finestone HM. The pain detective: every ache tells a story: understanding how stress and  emotional hurt become chronic physical pain. Santa Barbara, Calif: Praeger; 2009.  
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