Emergency Department: Pain as the Fifth Vital Sign

Author: Phyllis L. Hendry

Dr. Sheikh: With this new awareness of pain management in the Emergency Department, there’s a lot more interest and a lot more research being done. There’s still long ways for us to go developing actual tools that can be used in the ED setting. All the tools that are currently available are not really designed for our population. As for the key message behind pain as the fifth vital sign, it’s about communication. Communicating with our patients—performing pain assessments within the ED perimeters, discussing the barriers and challenges that go along with working that environment—that’s really where we can improve and where we should focus our energy so we can provide better care for patients when it comes to dealing with their pain.

Dr. Hendry: Pain is important. It’s called the fifth vital sign. That partially led to patient satisfaction scores, the HCAHPS scores, and two or three of those are based on pain. And even though they are hospital-based scores, your experience starts in the emergency department. So there’s talk about taking those pain components out of the patient satisfaction survey. I have mixed feelings about that because I do think pain management is important, but maybe we put a little bit too much emphasis there. It’s easy to just give an opioid and take the pain away, and what we really need to be looking at are other ways to treat pain. There’s a ton of nonpharmacological methods. We still need to be treating pain. It’s still important. But that’s the way hospitals were getting reimbursed. If you didn’t have high HCAHPS, it adversely affected you. Half to 78% of patients who come to the ED are there for pain related complaints, and so it is important. We do have to continue to look at that.

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