Title

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

Date of this Version

11-24-2015

Document Type

Journal Article

Publication Details

Citation only

Taylor, D., Fatovich, D. M., Finucci, D. P., Furyk, J., Jin, S., Keijzers, G., Macdonald, S. P. J., Mitenko, H., 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. Emergency Medicine Australasia, 27(6), 549-557.

Access the journal

2015 HERDC submission

© Copyright, Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine, 2015

ISSN

1742-6731

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 48 h 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.

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This document has been peer reviewed.