TY - JOUR
T1 - Best-practice pain management in the emergency department: A cluster-randomised, controlled, intervention trial
AU - Taylor, David Mcd
AU - Fatovich, Daniel M.
AU - Finucci, Daniel P.
AU - Furyk, Jeremy
AU - Jin, Sang Won
AU - Keijzers, Gerben
AU - Macdonald, Stephen P.J.
AU - Mitenko, Hugh M.A.
AU - Richardson, Joanna R.
AU - Ting, Joseph Y.S.
AU - Thom, Ogilvie N.
AU - Ugoni, Antony M.
AU - Hughes, James A.
AU - Bost, Nerolie
AU - Ward, Meagan L.
AU - Gibbs, Clinton R.
AU - Macdonald, Ellen
AU - Chalkley, Dane R.
PY - 2015/12/1
Y1 - 2015/12/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=84949591292&partnerID=8YFLogxK
U2 - 10.1111/1742-6723.12498
DO - 10.1111/1742-6723.12498
M3 - Article
C2 - 26600085
AN - SCOPUS:84949591292
SN - 1742-6731
VL - 27
SP - 549
EP - 557
JO - EMA - Emergency Medicine Australasia
JF - EMA - Emergency Medicine Australasia
IS - 6
ER -