(A420) Management of Prescription Pain Medication After Hospitalization and Surgery

Introduction: After the initial emergency department visit, trauma patients requiring surgery often face weeks of pain before surgery, leading to uncertainty about who—emergency physicians, primary care physicians, or trauma surgeons—should manage their pain medications. While guidelines emphasize the type, dosage, and delivery of analgesics, they fail to assign responsibility for prescribing.

Methods: As the first part of a Quality Improvement Project, we surveyed physicians responsible for the pain management of trauma patients. During November of 2024, a survey via the Research Electronic Data Capture (REDCap) software was administered of emergency, internal, and primary care, physicians, as well as general, plastic, neurologic, orthopedic, and ENT surgeons. Physicians were given five scenarios and asked who they thought should be responsible for prescribing.

Results: Collected survey data was organized into matrixes based on physician specialty and proposed prescriber and analyzed with chi-squared tests. In the scenario where a patient receives emergency surgery and is admitted to the hospital, surgeons are significantly more likely to choose the admitting team as responsible prescribers (P < 0.001). In the scenario where a trauma patient is admitted without receiving surgery, emergency physicians are significantly more likely to choose hospitalists as responsible prescribers (P < 0.001). No other significant relationship was noted.

Conclusions: This is the first step in a quality improvement project and was designed to elucidate potential relationships and validate a survey instrument. The scenarios presented in the survey reflect common situations a trauma team might encounter, yet in some cases, no standard of care was agreed upon. We highlight physician specialty as a source of differing opinions. This preliminary data brings us closer to answering the question of ‘who should prescribe?’ and helps bridge communication gaps among the multiple physicians responsible for a trauma patient’s care.