Best-practice pain management in the emergency department: A cluster-randomised, controlled, intervention trial

David Mcd Taylor*, Daniel M. Fatovich, Daniel P. Finucci, Jeremy Furyk, Sang Won Jin, Gerben Keijzers, Stephen P.J. Macdonald, Hugh M.A. Mitenko, Joanna R. Richardson, Joseph Y.S. Ting, Ogilvie N. Thom, Antony M. Ugoni, James A. Hughes, Nerolie Bost, Meagan L. Ward, Clinton R. Gibbs, Ellen Macdonald, Dane R. Chalkley

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

17 Citations (Scopus)

Abstract

Objectives: We aimed to provide 'adequate analgesia' (which decreases the pain score by ≥2 and to <4 [0-10 scale]) and determine the effect on patient satisfaction. Methods: We undertook a multicentre, cluster-randomised, controlled, intervention trial in nine EDs. Patients with moderate pain (pain score of ≥4) were eligible for inclusion. The intervention was a range of educational activities to encourage staff to provide 'adequate analgesia'. It was introduced into five early intervention EDs between the 0 and 6 months time points and at four late intervention EDs between 3 and 6 months. At 0, 3 and 6 months, data were collected on demographics, pain scores, analgesia provided and pain management satisfaction 48h post-discharge (6 point scale). 

Results: Overall, 1317 patients were enrolled. Logistic regression (controlling for site and other confounders) indicated that, between 0 and 3 months, satisfaction increased significantly at the early intervention EDs (OR 2.2, 95% CI 1.5 to 3.4 [P<0.01]) but was stable at the control EDs (OR 0.8, 95% CI 0.5 to 1.3 [P=0.35]). Pooling of data from all sites indicated that the proportion of patients very satisfied with their pain management increased from 42.9% immediately pre-intervention to 53.9% after 3 months of intervention (difference in proportions 11.0%, 95% CI 4.2 to 17.8 [P=0.001]). Logistic regression of all data indicated that 'adequate analgesia' was significantly associated with patient satisfaction (OR 1.4, 95% CI 1.1 to 1.8 [P<0.01]). 

Conclusions: The 'adequate analgesia' intervention significantly improved patient satisfaction. It provides a simple and efficient target in the pursuit of best-practice ED pain management.

Original languageEnglish
Pages (from-to)549-557
Number of pages9
JournalEMA - Emergency Medicine Australasia
Volume27
Issue number6
DOIs
Publication statusPublished - 1 Dec 2015

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    Taylor, D. M., Fatovich, D. M., Finucci, D. P., Furyk, J., Jin, S. W., Keijzers, G., Macdonald, S. P. J., Mitenko, H. M. A., Richardson, J. R., Ting, J. Y. S., Thom, O. N., Ugoni, A. M., Hughes, J. A., Bost, N., Ward, M. L., Gibbs, C. R., Macdonald, E., & Chalkley, D. R. (2015). Best-practice pain management in the emergency department: A cluster-randomised, controlled, intervention trial. EMA - Emergency Medicine Australasia, 27(6), 549-557. https://doi.org/10.1111/1742-6723.12498