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  • Print publication year: 2008
  • Online publication date: December 2009

10 - Pathways and Protocols for the Triage Patient with Acute Pain




Emergency departments (EDs) face many challenges. Recent data suggest that patient visits in United States EDs have increased 18% over the past 10 years and are now estimated to approximate 110 million visits annually. Pain is the most common symptom in which patients present to the ED. Up to 78% of all patients present to the ED with a chief complaint of pain.

Emergency providers have an important opportunity to intervene with analgesic agents at triage to provide analgesia to patients suffering pain. To affect this scheme, there is a need for nurse-driven analgesic protocols at triage.


ED crowding has recently been recognized as a critical problem by the Institute of Medicine. A national survey of eight EDs reported experiencing overcrowding 12–73% of the time (mean = 35%). A direct consequence of ED overcrowding is a prolonged time to evaluation by a physician.

Variability at individual institutions is common, and data from a prospective study conducted at a single site reports an average time to initial analgesic of 74 min. Time to pain assessment is also affected by ED overcrowding. Elderly patients with hip fractures have been described as experiencing significantly longer time to pain assessment when the ED is at capacity.

Delays associated with overcrowding leave many patients in the waiting room after the initial triage assessment by a nurse. Patients with pain are forced to wait for physician evaluation and potential pain relief.

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Emergency Sedation and Pain Management
  • Online ISBN: 9780511547225
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McCaig L, Nawar E. National Hospital Ambulatory Medical Care Survey: 2004 emergency department summary. In Centers for Disease Control and Prevention National Center for Health Statistics, vol. 372, ed. U.S. Department of Health and Human Services, 2006.
Tanabe, P, Buschmann, M. A prospective study of ED pain management practices and the patient's perspective. J Emerg Nurs 1999;25(3): 171–177.
Coman, M, Kelly, A. Safety of a nurse-managed, titrated analgesia protocol for the management of severe pain in the emergency department. Emerg Med 1999;11(3): 128–132.
Hwang, U, Richardson, LDSonuyi, TO et al. The effect of emergency department crowding on the management of pain in older adults with hip fracture. J Am Geriatr Soc 2006;54(2):270–275.
Beel, TL, Mitchiner, JCFrederiksen, SM et al. Patient preferences regarding pain medication in the ED. Am J Emerg Med 2000;18(4):376–380.
Stalnikowicz, R, Mahamid, RKaspi, S et al. Undertreatment of acute pain in the emergency department: A challenge. Int J Qual Health Care 2005;17(2):173–176.
Tanabe, P, Ferket, KThomas, R et al. The effect of standard care, ibuprofen, and distraction on pain relief and patient satisfaction in children with musculoskeletal trauma. J Emerg Nurs 2002;28(2):118–125.
Tanabe, P, Thomas, RPaice, J et al. The effect of standard care, ibuprofen, and music on pain relief and patient satisfaction in adults with musculoskeletal trauma. J Emerg Nurs 2001;27(2):124–131.
Larsen, D. An investigation into the assessment and management of pain by triage nurses in Greater London A&E departments. Emerg Nurs 2000;8(2):18–24.
Boyd, R, Stuart, P. The efficacy of structured assessment and analgesia provision in the paediatric emergency department. Emerg Med J 2005;22:30–32.
Campbell, P, Dennie, MDougherty, K et al. Implementation of an ED protocol for pain management at triage at a busy Level I trauma center. J Emerg Nurs 2004;30(5):431–438.
Seguin, D. A nurse-initiated pain management advanced triage protocol for ED patients with an extremity injury at a level I trauma center. J Emerg Nurs 2004;30(4): 330–335.
Meunier-Sham, J, Ryan, K. Reducing pediatric pain during ED procedures with a nurse-driven protocol: An urban pediatric emergency department's experience. J Emerg Nurs 2003;29(2):127–132.
Kelly, AM. A process approach to improving pain management in the emergency department: Development and evaluation. J Accid Emerg Med 2000;17(3):185–187.
Kelly, A, Brumby, C, Barnes, C.Nurse-initiated, titrated intravenous opioid analgesia reduces time to analgesia for selected painful conditionsCan J Emerg Med 2005;7(3):149–154.