Marek M, Lindsell CJ, Jauch EC, et al. Effect of education and guidelines for treatment of uncomplicated dental pain on patient and provider behavior. Ann Emerg Med 2004; 44:323-329.

Implementing guidelines for dental pain and giving patients resources for alternative treatments can reduce return visits and decrease narcotic prescriptions, says this study from the University of Cincinnati College of Medicine.

Dental pain is one of the most common complaints bringing patients to the ED and uses significant resources, but patients with uncomplicated dental pain are best served by primary care dentists due to lack of suitable resources and more expensive care, say the researchers.

To address this, guidelines were developed for ED care of uncomplicated toothache emphasizing the use of nonsteroidal anti-inflammatory drugs (NSAIDs) instead of narcotics, and giving patients a listing of local dental clinics that charge on a sliding scale based on income. The list was given to patients at triage, during evaluation, or at discharge.

After the guidelines were implemented, researchers reviewed 5,930 ED dental pain visits and found that return visits for toothache decreased by 10.6% within two months, and opiate prescriptions were reduced by 20.1%.

"Establishing guidelines that include information about available community dental resources and about effective nonprescription pain medications and that encourage the prescribing of nonsteroidal anti-inflammatory drugs for uncomplicated detail pain appears to reduce the prescribing of narcotic pain medications by physicians and reduces the burden of dental pain on the ED," the researchers conclude.

Gorelick MH, Yen K, Yun HJ. The effect of in-room registration on emergency department length of stay. Ann Emerg Med 2005; 45:128-133.

In-room registration reduces patients’ total length of stay significantly, says this study from the Children’s Hospital and Health System in Milwaukee.

The researchers compared ED visits from 2000-2003 after implementing a process in which patients were placed directly into a room after triage, and registration was completed after being seen by a physician. In-room registration resulted in an average decrease of length of stay of 15 minutes. The time savings was greater than expected, since the act of registration takes only five minutes, note the researchers.

"We speculate that this effect may be a result of a change in the mindset of the ED staff, from seeing the waiting room, and waiting in general, as acceptable and even expected to a view of expediting care in all phases of the ED visit," they wrote.

The researchers noted that previous studies have shown similar benefits, but generally with changing multiple processes simultaneously. "Changing a single process of care — going from a serial to a parallel, in-room registration process — was associated with a significantly decreased length of stay in an academic pediatric ED, even with adjustment for other factors found to influence length of stay, including ED census, admissions from the ED, hospital occupancy, and month of the year," they conclude.