PATIENTS' PAIN ASSESSMENT AND MANAGEMENT IN AN EMERGENCY DEPARTMENT

M. Galletta¹, C. Delogu², L. Lai³, G. Finco¹, I. Piras⁴ | ¹Department of Medical Sciences and Public Health, University of Cagliari; ²Santissima Trinità Hospital, ASL Cagliari; ³Neonatal Pathology Lattarium and TIN, AOU Monserrato, Cagliari; ⁴Clinical Trials Sector, General Affairs, "A. Cao" Microcythemia Hospital, ASL Cagliari

INTRODUCTION
Pain is the most frequent reason for admission to the emergency department (ED), so accurate assessment and timely treatment is one of the main goals for better pain management by staff. The Joint Commission on Accreditation of Healthcare Organization and national guidelines for pain management in the PS stipulate that all users be evaluated for pain and receive appropriate treatment.
AIM
The aim of the study is to know nurses' behavior about pain assessment in triage and patients' perceptions of effectiveness and satisfaction.
METHODS
The prospective observational study was conducted from May to June 2022. A checklist of 15 indicators investigating demographic aspects, color code, pain site, pain assessment, waiting time and patient satisfaction was used. Patients were recruited at the time of triage in the PS. Patients were followed through the entire process from admission to discharge. Before discharge, patients were asked to rate the effectiveness of treatment and satisfaction with the treatment received.
RESULTS
A total of 586 patients were recruited of whom 289 males (49.3%) and 297 females (50.7%) with a mean age of 49.8 years. Pain assessment is performed in 95% of cases, however, pain intensity is assessed in 61% of cases mainly with NRS scale. In 87% of the sample, nurses correlate pain with the patient's presenting problem at triage, and only in 28% of cases do nurses report the patient's pain to the physician. The time lag from the patient's admission to the physician's decision on the treatment to be given is variable (p<0.001). In 24% of cases, intake occurs from 1 to 30 minutes, and up to 1 hour or over 2:30 hours for about 60% of cases. Mostly, patients rate the intervention received as sufficiently (41%) and fairly (48%) effective. Nine percent give a good evaluation. More specifically, patients report a 3-point decrease in pain on an NRS scale for about 49% and a 5-point decrease for 34% of patients. The results are in line with the patient's final rating of the analgesic treatment received. Forty-seven percent of patients said they were fairly satisfied, 29% were sufficiently satisfied, and 18% reported a good rating. Ratings on the treatment received are equally distributed between fair and sufficient for all time intervals from admission to intake, and there is no difference according to waiting time [X2(df=28)=33.5, p=0.217]. For those who reported a good rating, the response rate seems to decrease as the waiting time increases (from 32% for 1-30 minutes, to 3% for over 7 hours of waiting).
CONCLUSIONS
The results suggest the need to improve pain intensity assessment protocols and strengthen nurse-physician communication at triage to ensure faster and more targeted care. Although treatment efficacy and overall patient satisfaction are at acceptable levels, variability in waiting times and the impact of prolonged waits on patient ratings would indicate a need to optimize diagnostic-therapeutic pathways in emergencies.