Arendt KW, Sadosty AT, et al. The left-without-being-seen patients: What would keep them from leaving? Ann Emerg Med 2003; 42:317-323.

By communicating with patients about estimated waiting time and performing immediate treatments for minor injuries or symptoms, you may be able to prevent patients from leaving without being seen, says this study from Mayo Medical School, Mayo Medical Center, and Mayo Graduate School of Medicine, all based in Rochester, MN.

The researchers contacted 97 patients who had left an ED without being seen and asked them if specific services would have prevented them from leaving the ED. Of these, 70.1% said that immediate temporary treatments such as an ice pack for an injury or bandage for a laceration would have helped them wait longer, and 84.5% said that more frequent updates on wait time would have resulted in them waiting longer.

Some patients said that an estimate of wait time would have allowed them to take care of personal business such as making necessary telephone calls or obtaining food for themselves or a child. Also, according to the survey, the absence of comfort measures such as a television, coffee, or comfortable chairs didn’t cause patients to leave without being seen.

The researchers recommend the following:

  • Have the triage nurse ask if there is anything the patient needs while they are waiting. This might uncover less obvious needs, such as the need for a cool compress for a headache, the researchers suggest.
  • Ensure that nurses communicate well with patients while they are waiting for a formal consultation with a physician.
  • Put available resources into customer service education for ED personnel instead of waiting room improvements.
  • Make on-site day care available for free or at a minimal charge, as this may help patients with a child to wait longer.

Brown JC, Klein EJ, Lewis CW. Emergency department analgesia for fracture pain. Ann Emerg Med 2003; 42:197-205.

Pain medications frequently are not given to patients with fractures, pain severity scores are often not recorded, and pediatric patients are least likely to receive analgesics, according to this study from the University of Washington and Children’s Hospital and Regional Medical Center, both based in Seattle. Here are key findings:

• Of 2,828 patients with isolated closed fractures of the extremities or clavicle, 64% received an analgesic. This percentage decreased to 58% for patients 70 years and older, and 54% for patients ages 0 to 3.

• Pain severity scores were recorded for 59% of patients overall and in only 47% of children younger than 4.

• Even for patients with documented moderate or severe pain, 73% of patients overall and 62% of children younger than 4 years received an analgesic.

"Educating providers on nonverbal options for measuring pain, especially in young children, may improve measurement and documentation of pain status and facilitate recognition and treatment of pain in these vulnerable populations," conclude the researchers.

In light of these findings, the researchers recommend using the following strategies to improve pain management in the ED:

  • Use simple pain scales for nonverbal patients and infants and young children.
  • Assess adequacy of pain management in very old and very young patients.
  • Educate staff about the safety of narcotic medications even in young children.
  • Emphasize the importance of documenting pain severity scores in all patients including infants, who had fewer pain severity scores recorded than any other group.