Procedural pain management in an academic emergency department, a pilot study

Pain is the leading cause of Emergency Department (ED) visits and untreated acute pain can frequently transition to chronic pain. (1,2) A 2020 pilot study showed that an ED-physician-led procedural pain management program reduced pain. (3) Our objective was to determine the feasibility and usefulness of a Mobile ED (MED) Pain Management program led by a dual-trained Pain Management and Emergency physician. We included adult patients who visited the ED at a large academic hospital between October 26th and November 17th, 2020. Patients had a variety of types of pain and were treated with bedside nerve blocks. We recorded procedure indication, demographic data, and pre-and-post Visual Analog Scale (VAS) pain scores. We also captured patient and provider satisfaction, and billing data. The MED team was available for a total of 30 h and performed 14 procedures on 12 patients and 4 consults without procedures on 4 additional patients. VAS 30-min score reductions ranged from 20 % (intercostal nerve blocks) to 100 % erector spinae plane block (ESPB). The average VAS pain reduction was 58 %. The most common procedure performed was the ESPB with mean VAS pain reduction of 74 %. The procedures and consults produced 50.13 RVUs total and work Relative Value Units (wRVUs) of 29.4. Average RVU was 3.13 (1.84 wRVU) per patient and 1.67 RVU (0.98 wRVU) per hour. These preliminary data suggest that although implementation of a dedicated ED pain could potentially lead to improved pain relief, it may not be financially feasible in this setting.