{"pk":10395,"title":"Emergency Department Pain Management Following Implementation of a Geriatric Hip Fracture Program","subtitle":null,"abstract":"Introduction:\n Over 300,000 patients in the United States sustain low-trauma fragility hip fracturesannually. Multidisciplinary geriatric fracture programs (GFP) including early, multimodal painmanagement reduce morbidity and mortality. Our overall goal was to determine the effects of a GFPon the emergency department (ED) pain management of geriatric fragility hip fractures.\nMethods:\n We performed a retrospective study including patients age ≥65 years with fragility hipfractures two years before and two years after the implementation of the GFP. Outcomes were timeto (any) first analgesic, use of acetaminophen and fascia iliaca compartment block (FICB) in the ED,and amount of opioid medication administered in the first 24 hours. We used permutation tests toevaluate differences in ED pain management following GFP implementation.\nResults:\n We studied 131 patients in the pre-GFP period and 177 patients in the post-GFP period.In the post-GFP period, more patients received FICB (6% vs. 60%; difference 54%, 95% confidenceinterval [CI] 45-63%; p<0.001) and acetaminophen (10% vs. 51%; difference 41%, 95% CI 32-51%;p<0.001) in the ED. Patients in the post-GFP period also had a shorter time to first analgesic (103vs. 93 minutes; p=0.04) and received fewer morphine equivalents in the first 24 hours (15mg vs.10mg, p<0.001) than patients in the pre-GFP period.\nConclusion:\n Implementation of a GFP was associated with improved ED pain management forgeriatric patients with fragility hip fractures. Future studies should evaluate the effects of thesechanges in pain management on longer-term outcomes.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Hip Fractures"},{"word":"Geriatrics"},{"word":"pain management"}],"section":"Treatment Protocol Assessment","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1qg2w61b","frozenauthors":[{"first_name":"Scott","middle_name":"D.","last_name":"Casey","name_suffix":"","institution":"University of California, Davis School of Medicine, Department of Emergency Medicine, Sacramento, California","department":"None"},{"first_name":"Dane","middle_name":"E.","last_name":"Stevenson","name_suffix":"","institution":"University of California, Davis School of Medicine, Department of Emergency Medicine, Sacramento, California","department":"None"},{"first_name":"Bryn","middle_name":"E.","last_name":"Mumma","name_suffix":"","institution":"University of California, Davis School of Medicine, Department of Emergency Medicine, Sacramento, California","department":"None"},{"first_name":"Christina","middle_name":"","last_name":"Slee","name_suffix":"","institution":"UC Davis Medical Center, Department of Quality and Safety, Sacramento, California","department":"None"},{"first_name":"Philip","middle_name":"R.","last_name":"Wolinsky","name_suffix":"","institution":"University of California, Davis School of Medicine, Department of Orthopaedic Surgery, Sacramento, California","department":"None"},{"first_name":"Katren","middle_name":"","last_name":"Tyler","name_suffix":"","institution":"UC Davis","department":"None"},{"first_name":"Calvin","middle_name":"H.","last_name":"Hirsch","name_suffix":"","institution":"University of California, Davis School of Medicine, Department of Internal Medicine, Sacramento, California","department":"None"}],"date_submitted":"2016-10-16T04:17:39Z","date_accepted":"2016-10-16T04:17:39Z","date_published":"2017-04-19T20:57:19Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/10395/galley/5716/download/"}]}