Professional Pain Management Strategies in the Emergency Department for Patients With Critical Illnesses

Background: Pain is a leading reason for emergency department (ED) visits among patients with critical illness (PWCIs), yet pain management remains inconsistent and often suboptimal. The lack of standardized protocols and documentation gaps further complicates effective care. Objectives: This study aimed to characterize pain assessment and management practices for PWCIs in the ED and basic emergency service (BES) and identify improvement opportunities. Methods: A retrospective analysis was performed on 10,802 patient records from a major hospital in northern Portugal. Adults with moderate or severe pain, triaged as yellow, orange, or red, were included over a 90-day period. Data on pain assessment, interventions, and reassessment were analyzed using descriptive statistics. Results: Of 27,212 episodes, 96.3% involved pain as the primary complaint. Physicians were the main prescribers of pharmacological measures, especially in higher-priority cases, while nonpharmacological interventions were underutilized. Documentation of pain reassessment was incomplete, with significant gaps in both physician and nursing records. No nurse-initiated analgesia protocol was in place during the study period. Conclusions: This study highlights persistent gaps in pain management for PWCIs in the ED and BES. The implementation of targeted protocols, ongoing training, and regular audits has the potential to significantly improve pain management practices and patient outcomes. Continued focus on multidisciplinary collaboration and evidence-based protocols is essential for advancing emergency care quality.