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An interventional study to improve the quality of analgesia in the emergency department

Published online by Cambridge University Press:  21 May 2015

Michael Yanuka ,
Dror Soffer  and
Pinchas Halpern
Michael Yanuka
Affiliation:
Department of Emergency Medicine, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Dror Soffer
Affiliation:
Department of Emergency Medicine, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Pinchas Halpern*
Affiliation:
Department of Emergency Medicine, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
*
Emergency Department, Tel Aviv Sourasky Medical Center, 6 Weitzman St., Tel Aviv 64239, Israel; dr_halperin@tasmc.health.gov.il

Abstract

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Objective:

We sought to document the adequacy of acute pain management in a high-volume urban emergency department and the impact of a structured intervention.

Methods:

We conducted a prospective, single-blind, pre- and postintervention study on patients who suffered minor-to-moderate trauma. The intervention consisted of structured training sessions on emergency department (ED) analgesia practice and the implementation of a voluntary analgesic protocol.

Results:

Preintervention data showed that only 340 of 1000 patients (34%) received analgesia. Postintervention data showed that 693 of 700 patients (99%) received analgesia, an absolute increase of 65% (95% CI 61%–68%), and that delay to analgesia administration fell from 69 (standard deviation [SD] 54) minutes to 35 (SD 43) minutes. Analgesics led to similar reductions in visual analog pain scale ratings during the pre- and postintervention phases (4.5 cm, SD 2.0 cm, and 4.3 cm, SD 3.0 cm, respectively).

Conclusion:

Our multifaceted ED pain management intervention was highly effective in improving quality of analgesia, timeliness of care and patient satisfaction. This protocol or similar ones have the potential to substantially improve pain management in diverse ED settings.

Keywords

emergency departmentanalgesiatrainingimprovementprotocols
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 10 , Issue 5 , September 2008 , pp. 435 - 439
Copyright
Copyright © Canadian Association of Emergency Physicians 2008

References

1.Wilson, JE, Pendelton, JM. Oligoanalgesia in the emergency department. Am J Emerg Med 1989;7:620–3.CrossRefGoogle ScholarPubMed
2.Wall, D, Melzack, R. Textbook of pain, 4th ed. London (UK): Churchill Livingstone, 1999. p. 448.Google Scholar
3.Guttman, S. Halpern, P. Effects of gender on pain perception and treatment in the emergency department. Abstract presented at the First Mediterranean Emergency Medicine Congress, Stresa, Italy, September 2001.Google Scholar
4.Todd, KH, Deaton, C, D’Adamo, AP, et al.Ethnicity and analgesic practice. Ann Emerg Med 2000;35:11–3.Google Scholar
5.Jones, JS, Johnson, K, McNinch, M. Age as a risk factor for inadequate emergency department analgesia. Am J Emerg Med 1996;14:157–60.Google Scholar
6.Ducharme, J. Acute pain and pain control: state of the art. Ann Emerg Med 2000;35:592–602.Google Scholar
7.Myles, PS, Troedel, S, Boquest, M, et al.The pain visual analog scale: Is it linear or nonlinear? Anesth Analg 1999;89:1517–20.CrossRefGoogle ScholarPubMed
8.Morgan-Jones, R. Pre-operative analgesia after injury. Injury 1996;27:539.41.Google Scholar
9.Jantos, TJ, Paris, P, Menegazzi, JJ, et al.Analgesic practice for acute orthopedic trauma pain in Costa Rican emergency department. Ann Emerg Med 1996;28:145–9.CrossRefGoogle Scholar
10.Lewis, LM, Lasater, LC, Brooks, CB. Are emergency physicians too stingy with analgesics? South Med J 1994;87:1–9.Google Scholar
11.Friedland, LR, Kulick, RM. Emergency department analgesic use in pediatric trauma victim with fractures. Ann Emerg Med 1994;23:203–7.Google Scholar
12.Jones, JB. Assessment of pain management skills in emergency medicine residents: the role of pain education program. J Emerg Med 1999;17:349–54.CrossRefGoogle Scholar
13.Kelly, AM. A process approach to improving pain management in the emergency department: development and evaluation. J Accid Emerg Med 2000;17:185–7.CrossRefGoogle ScholarPubMed
14.Sucov, A, Nathanson, A, Proano, L, et al.An educational program can increase the likelihood of fracture patient receiving analgesia in the ED. Acad Emerg Med 2001;8:427.Google Scholar
15.Nelson, BP, Cohen, D, Lander, O, et al.Mandated pain scales improve frequency of ED analgesic administration. Am J Emerg Med 2004;22:582–5.CrossRefGoogle ScholarPubMed
16.Kelly, AM, Brumby, C, Barnes, C. Nurse-initiated, titrated intravenous opioid analgesia reduces time to analgesia for selected painful conditions. CJEM 2005;7:149–54.Google Scholar
17.Rudman, N, McIlmail, D. Emergency department evaluation and treatment of hip and thigh injuries. Emerg Med Clin North Am 2000;18:29–66.Google Scholar
18.Fletcher, AK, Rigby, AS, Heyes, FL. Three-in-one femoral nerve block as analgesia for fractured neck of femur in the emergency department: a randomized, controlled trial. Ann Emerg Med 2003;41:227–33.Google Scholar
19.Hersen, M, Bellack, AS. A. Multiple-baseline analysis of social-skills training in chronic schizophrenics. J Appl Behav Anal 1976;9:239–45.Google Scholar
20.Campbell, MJ. Cluster randomized trials in general (family) practice research. Stat Methods Med Res 2000;9:81–94.Google Scholar
21.Brown, CA, Lilford, RJ,. The stepped wedge trial design: a systematic review. BMC Med Res Methodol 2006;6:54.Google Scholar