Simple Changes to Emergency Department Workflow Improve Analgesia in Mechanically Ventilated Patients

The Western Journal of Emergency Medicine
Derek L IsenbergLoreen B Evans

Abstract

In 2013 the Society for Critical Care Medicine (SCCM) published guidelines for the management of pain and agitation in the intensive care unit (ICU). These guidelines recommend using an analgesia-first strategy in mechanically ventilated patients as well as reducing the use of benzodiazepines. Benzodiazepines increase delirium in ICU patients thereby increasing ICU length of stay. We sought to determine whether a simple educational intervention for emergency department (ED) staff, as well as two simple changes in workflow, would improve adherence to the SCCM guidelines. This was a cohort study that took place from 2014-2016. All patients who were intubated in the ED by an emergency physician (EP) during this time were eligible for inclusion in this study. In January 2015, we began an educational campaign with the ED staff consisting of a series of presentations and online trainings. The impetus for our educational campaign was to have best practices in place for our new emergency medicine residency program starting in July 2016. We made two minor changes in our ED workflow to support this educational objective. First, fentanyl infusions were stocked in the ED. Second, we instituted a medication order set for mechanically ventil...Continue Reading

References

Apr 15, 2004·JAMA : the Journal of the American Medical Association·E Wesley ElyRobert S Dittus
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Sep 19, 2017·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Corey HeitzWilliam K Milne

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Citations

Apr 29, 2020·Journal of Evaluation in Clinical Practice·Klay LamprellJeffrey Braithwaite

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