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

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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.

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





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.


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).


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]).


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.