CLINICAL AUDIT ON ABDOMINAL PAIN

TRIAGE AT EMERGENCY DEPARTMENT

HOSPITAL SUNGAI BAKAP

MEDICAL OFFICERS HSB

Members
Dr. Prassaad Arujunan (Leader)
Dr. Sanmuga (Assistant leader)
Dr. Kabilen
Dr. Lim Boon Poh
Introduction
Abdominal pain continues to pose
diagnostic challenges for emergency
clinicians
In many cases, the differential diagnosis
is wide, ranging from benign to life-
threatening conditions.
Causes include medical, surgical,
intraabdominal, and extraadominal
eliments

-JL Kendall, ME Moreira, RS Hockberger

UpToDate.(level 5),2011
Introduction
In Emergency Department, Hospital
Sungai Bakap, patients that come with
abdominal pain are triaged based on
their pain score.
Pain is the 5th vital sign
Pain is subjective, so no satisfactory
objective measures of pain exist
In our setting Combination Rating Scale
(Numerical Rating scale + Visual
Analogue Score) and Wong Bakers
Scale are used to determine the pain
score
Introduction
Problem Statement
On 7/2/2016, A 52 years old, Malay,
Man came to Emergency Department
complaining of abdominal pain
The pain score given at the triage
counter was 1/10. Therefore the
patient was triaged to green zone
Once the patient was seen by doctor,
the provisional diagnosis was
obstructed irreducible inguinal hernia
Problem statement
Patient with this provisonal
diagnosis should be triaged to
yellow zone
This is because, when the patient
is triaged to green zone, there is
a delay in management and this
may lead to complications such
perforation and peritonitis which
are life threatening
Problem statement
Pain score alone cannot be used
to triage a patient with
abdominal pain
Pain score assessment is difficult
Main Objective
Tofind number of patients with
abdominal pain that are
mistriaged after office hours
Specific Objectives
To determine the effectiveness of
triaging patients with abdominal
pain based on pain score
To find a proper method of
triaging patients with abdominal
pain
Sampling Criteria
Inclusion
All cases of abdominal pain that
comes to Emergency Department
Hospital Sungai Bakap
Exclusion
Office hours
Accident cases
 Methodology

Prospective study
Analysis Data
Total number of patients with
abdominal pain that came to
Emergency Department from
1/3/13 to 15/3/17 is 70
All patients was given pain score
less than 4
All patients was triaged to green
3 patients were wrongly triaged
 Right Wrong Mistriaged
Dates Pain score Triage Zone Triage Triage diagnosis
<4 4 to 8 >8 Green Yellow Red
1/3/2017 1 1 1
2/3/2017 5 5 5
3/3/2017 8 8 7 1 Acute Cholangitis
4/3/2017 5 5 5
5/3/2017 6 6 6
6/3/2017 7 7 6 1 Subacute I/O
7/3/2017 4 4 4
8/3/2017 5 5 5
9/3/2017 3 3 3
10/3/201
7 1 1 1
11/3/201
7 0 0 0
12/3/201
7 9 9 8 1 Acute Appendicitis
13/3/201
7 9 9 9
14/3/201
7 0 0 0
15/3/201
7 7 7 7
70 0 0 70 67 3
Analysis Graph
Intervention Plan
To display Wong Baker Faces
scale at triage counter for proper
assessment of pain
To have a PSCL checklist form at
triage counter for abdominal pain
INTERVENTION
PSCL
REFERENCES
Rubin S, Michalowski W, Slowinski R. In:Developing an
emergency room diagnostic checklist using rough sets: A
case study of appendicitis.Simulation in the Medical
Sciences Proceedings of the 1996 Western
Multiconference.Anderson JG, Katzper M, editors. San Diego:
The Society for Computer Simulation; 1996. pp. 1924.
Andrew E Mulberg.Telephone Triage of Abdominal
Pain-Medscape-Oct28,2004. (Accessed on 20 April 2017)
BAEM Clinical Effectiveness Committee Guidelines For The
Management Of Pain in adults 2005. Available at
http:www.emergencymed.org.uk pdf ( Accessed on 20 April
2017)
Guideline National Nursing Audit, Ministry of Health Malaysia
2014
PKP Edt 9/2008 Pain as 5th vital sign training module for
paramedics
PSCL
SECOND CYCLE DATA
COLLECTION
PROSPECTIVE STUDY
1ST MAY 2017 TILL 15TH MAY 2017
FOR ALL NON TRAUMA
ABDOMINAL PAIN PATIENTS AFTER
OFFICE HOURS AT ED HSB
USING PSCL PROVIDED AT ED
HSB COUNTER