COMMUNITY CARE
patients who were denied narcotics in the ED could
not simply get them from another health care provider.
Electronic health records that were accessible by most
major health care facilities within a 150-mile radius were
key. Computerized prompts alerted staff members in
any participating ED or doctor’s offce that a patient was
enrolled in a pain care management program.
A S T O R Y O F S U C C E S S
Local physicians were an important piece in the pro-
gram’s success. They agreed to see patients to follow
up after an emergency visit, regardless of the patient’s
ability to pay.
Just three years after the program began, ED visits
for people repeatedly seeking pain medication were
reduced by 77 percent, from 3,689 the year before the
program started to 852 the year after. More good news:
The percentage of patients in
the program who had a pri-
mary care doctor rose from
42 percent to 89 percent.
The program has improved
care for people seeking relief
from pain and freed ED staff
to spend more time caring for
other patients. It is also likely
the program has had a positive
effect on rates of addiction and
crime in the community.
A Problem
With Pain
W H E N M E D I C A T I O N
I S T H E P R O B L E M ,
N O T T H E A N S W E R
Bat Masterson, RN, case
manager, Kootenai Health
By Kim Anderson
PRE SCR I PT I ON DRUG ADD I CT I ON HAS
s tol en the headlines lately. Little wonder given
the potency of these drugs and the ease with which
some people become addicted. Nurses and doctors in
hospital emergency departments (ED) are on the front
lines of the battle to prevent the problem. Recently,
work started at Kootenai Health in 2006 has been
drawing national attention to the topic in a variety of
health care journals.
In 2006, Bat Masterson, a registered nurse and case
manager in Kootenai Health’s ED, decided to take on the
challenge of reducing the number of patients who were
repeatedly coming to the ED with complaints of pain.
“At that time, the ED saw 48,949 patients per year,”
Masterson said. “Thirty-six percent of these visits were
for pain or pain-related complaints. Physicians were
spending nearly 20 hours of their 56-hour week with
these patients.”
With support fromKootenai Health’s leadership, Mas-
terson created a team that included doctors, nurses, social
workers and case managers. As the program grew, it
added more specialized physicians, including a psy-
chiatrist specialized in treating addiction.
I M P O R T A N T F I R S T S T E P S
The team set out to coordinate the care that patients with
chronic pain were receiving from their primary care doc-
tors and the ED. They hoped to use non-narcotic pain
relievers whenever appropriate and provide the best
care for every patient’s unique condition.
“We felt that improving the communication between
the primary care providers in the community and the
emergency department staff was imperative,” Master-
son said. “Every patient who came to the emergency
department with a complaint of pain was seen by a case
manager. Patients were monitored over time, and the
history of their visits to the emergency department and
their primary care doctor was periodically reviewed.”
The team worked closely with local physicians so
KOO T E NA I
H E A L T H
. OR G
5