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

Autor: David McD, Taylor, Daniel M, Fatovich, Daniel P, Finucci, Jeremy, Furyk, Sang-Won, Jin, Gerben, Keijzers, Stephen Pj, Macdonald, Hugh Ma, Mitenko, Joanna R, Richardson, Joseph Ys, Ting, Ogilvie N, Thom, Antony M, Ugoni, James A, Hughes, Nerolie, Bost, Meagan L, Ward, Clinton R, Gibbs, Ellen, Macdonald, Dane R, Chalkley
Rok vydání: 2015
Zdroj: Emergency medicine Australasia : EMA. 27(6)
ISSN: 1742-6723
Popis: We aimed to provide 'adequate analgesia' (which decreases the pain score by ≥2 and to4 [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.
Databáze: OpenAIRE