Emergency medicine practice is characterized by the need to make rapid decisions in the necessary face of diagnostic uncertainty. Nowhere is this tension more evident than in an emergency physician's assessment of pain and decision to prescribe opioid analgesics. Pain is the most common single reason for emergency department (ED) visits and rates of substance abuse (including prescription opioid misuse, abuse and diversion) are higher among those served by the ED than in the general population. Emergency physicians' opioid prescribing practices vary widely, even within individual practice groups and small geographic areas. Much of this variation is driven by individual biases regarding the management of pain and the lack of outcome data among patients treated in the ED that should inform practice.
Our proposal addresses this problem by promoting a more consistent approach to ED opioid prescribing practice, driven by the best evidence currently available and through the development of a regional emergency department pain registry to better monitor outcomes among patients treated in the ED and to provide patient-mediated feedback to individual emergency physicians, thus driving improvements in opioid prescribing practice. In meeting these objectives our project will address two key limitations of current ED pain treatment practice: (1) lack of patient outcome data, and (2) lack of physician feedback.