An interventional study to improve the quality of analgesia in the emergency department.(EM Advances)(Report)

Publication: Canadian Journal of Emergency Medicine

Publication Date: 01-SEP-08

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COPYRIGHT 2008 Canadian Medical Association

ABSTRACT

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 department, analgesia, training, improvement, protocols

RESUME

Objectif : Nous avons cherche a determiner si la gestion de la douleur aigue dans une salle d'urgence en milieu urbain est adequate et quel serait l'impact d'une intervention structuree.

Methodes : Nous avons realise une etude prospective, a simple insu, pre- et post-intervention, portant sur les patients ayant subi un traumatisme leger a modere. L'intervention consistait en seances de formation structurees sur les pratiques analgesiques en salle d'urgence et la mise en application volontaire d'un protocole analgesique.

Resultats : Les donnees pre-intervention ont revele que seulement 340 des 1 000 patients (34 %) ont recu une analgesie. Les donnees post-intervention ont indique, par ailleurs, que 693 des 700 patients (99 %) ont recu un analgesique, ce qui correspond a une augmentation absolue de 65 % [intervalle de confiance (IC) a 95 %, 61 a 68 %,], et que le retard d'administration d'un analgesique est passe de 69 minutes [ecart-type (ET) de 54 min] a 35 minutes (ET de 43 min). L'administration d'analgesiques a entraine une reduction des scores sur l'echelle visuelle analogue pendant les phases pre- et post-intervention [4,5 cm (ET de 2,0 cm) et 4,3 cm (ET de 3,0 cm) respectivement].

Conclusion : Notre intervention de gestion de la douleur aigue a multiples facettes realisee en salle d'urgence a ete tres efficace dans l'amelioration de la qualite de l'analgesie, l'acces rapide aux soins et la satisfaction des patients. Ce protocole ou des protocoles similaires peuvent ameliorer considerablement la gestion de la douleur dans divers types de salles d'urgence.

Introduction

Many studies have reported that emergency physicians and nurses frequently undertreat pain and that most emergency department (ED) patients do not receive adequate, timely analgesia. (1) This phenomenon, termed oligoanalgesia, is also common in the treatment of patients...

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