Conversations about analgesics in the emergency department: A qualitative study

Objective We sought to characterize conversations about analgesics in the Emergency Department (ED) setting. Methods A secondary analysis of 47 audio-recorded ED visits containing conversations about analgesics was performed. Data were collected at an urban, academic medical center among adults with one of four diagnoses. Visit transcripts were analyzed qualitatively using content and constant comparative analysis. The speaker, medication being discussed, and overall conversation concordance were categorized. Results Among the 47 transcripts there were 1102 unique statements related to analgesics. Thirteen codes were identified; however, four codes (discussing details of administration, forecasting, side effects, past history) accounted for over 65% of the conversations. Patient requests, statements related to chronic pain and contentious conversations occurred infrequently, but were present (17% discordant conversations, 83% concordant). Medical providers dominated the conversations with patients' contributions equaling only a quarter of total coded conversation. Conclusions These findings characterize the narrow range of topics discussed about analgesics and demonstrate that many risks of opioid medications were not discussed. Practice Implications Increased counseling about opioids may be warranted given rising opioid-related deaths. To be prepared, providers may wish to reflect on how to approach different topics related to opioids and analgesia prior to engaging in such discussions.