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

Taylor, David McD, Fatovich, Daniel M., Finucci, Daniel P., Furyk, Jeremy, Jin, Sang-Won, Keijzers, Gerben, Macdonald, Stephen P. J., Mitenko, Hugh M. A., Richardson, Joanna R., Ting, Joseph Y. S., Thom, Ogilvie N., Ugoni, Antony M., Hughes, James A., Bost, Nerolie, Ward, Meagan L., Gibbs, Clinton R., Macdonald, Ellen and Chalkley, Dane R. (2015) Best-practice pain management in the emergency department: a cluster-randomised, controlled, intervention trial. EMA - Emergency Medicine Australasia, 27 6: 549-557. doi:10.1111/1742-6723.12498

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Author Taylor, David McD
Fatovich, Daniel M.
Finucci, Daniel P.
Furyk, Jeremy
Jin, Sang-Won
Keijzers, Gerben
Macdonald, Stephen P. J.
Mitenko, Hugh M. A.
Richardson, Joanna R.
Ting, Joseph Y. S.
Thom, Ogilvie N.
Ugoni, Antony M.
Hughes, James A.
Bost, Nerolie
Ward, Meagan L.
Gibbs, Clinton R.
Macdonald, Ellen
Chalkley, Dane R.
Title Best-practice pain management in the emergency department: a cluster-randomised, controlled, intervention trial
Journal name EMA - Emergency Medicine Australasia   Check publisher's open access policy
ISSN 1742-6731
Publication date 2015-12
Year available 2015
Sub-type Article (original research)
DOI 10.1111/1742-6723.12498
Open Access Status Not Open Access
Volume 27
Issue 6
Start page 549
End page 557
Total pages 9
Place of publication Richmond, VIC Australia
Publisher Wiley-Blackwell Publishing Asia
Collection year 2016
Language eng
Formatted abstract
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.
Keyword Analgesia
Best practice
Emergency department
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Medicine Publications
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Created: Thu, 31 Mar 2016, 12:15:28 EST by Kristen Gibbons on behalf of School of Medicine