Abdominal Pain in the ED: What’s Taking So Long?

With years of nursing experience in the emergency department (ED), Karen Guzi, MSN, RN, ACNS-BC, BCEN, decided to tackle a research project about one of the most common complaints seen in EDs – stomach pain. “Abdominal pain is the No. 1 reason patients come to the ED,” says Guzi, a Clinical Nurse Specialist in Emergency Services at Cleveland Clinic. “It’s also a diagnosis that takes a significant amount of time to work up. Yet there’s little research that examines how patient, nurse and organizational factors affect length of stay in this population.”

As healthcare reform drives the need for improved and appropriate access to care, emergency departments are increasingly challenged to streamline throughput. “If we can take a few minutes to a half hour off of the time adults with abdominal pain spend in the ED, we can improve throughput for all patients,” says Guzi.

Research design, procedures and findings

Guzi teamed with research mentor Sandra Siedlecki, PhD, RN, CNS, Senior Nurse Scientist at Cleveland Clinic on the project, “Abdominal Pain in the ED: What Is Taking So Long?” As part of the descriptive study, they extracted a list of all eligible subjects (adults over 18 years old with complaints of abdominal pain) who presented to the ED between Jan. 1 and Dec. 31, 2014. A random sample of subjects was then selected using a random number table, from which demographic, encounter-specific and time-sensitive data was collected, recorded and analyzed.

Guzi and Dr. Siedlecki examined data from 100 patient records. The sample included nearly equal numbers of patients with acute and chronic pain conditions. Of patients sampled, 70 percent were seen in the ED and discharged to home, and 30 percent were admitted to the hospital.

“We looked at multiple variables to determine if they were associated with length of time someone spent in the ED,” says Guzi.

Important variables included:

• Use of nurse-initiated triage protocols
• Nursing shift during which patients arrived in the ED
• Patient demographics, including sex and age
• Length of time it took nurses to initiate triage protocols
• Need for imaging testing
• Medications in the ED
• Pain rating
• Discharge disposition (home versus hospital admission)

Of note, only 7 percent of patients with abdominal pain were treated using nurse-initiated triage protocols.

Implications for practice

Use of nurse-initiated triage protocols and optimization of the transfer process from ED to the floor could reduce length of stay in this population. “Just these two changes could reduce the average length of stay by 23 percent for patients being admitted and by 14 percent for patients being discharged,” concludes Guzi.