Title |
Best‐practice pain management in the emergency department: A cluster‐randomised, controlled, intervention trial
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Published in |
Emergency Medicine Australasia, November 2015
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DOI | 10.1111/1742-6723.12498 |
Pubmed ID | |
Authors |
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 |
Abstract |
We aimed to provide 'adequate analgesia' (which decreases the pain score by ≥2 and by <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. |
X Demographics
Geographical breakdown
Country | Count | As % |
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Ecuador | 1 | 25% |
United States | 1 | 25% |
Unknown | 2 | 50% |
Demographic breakdown
Type | Count | As % |
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Members of the public | 4 | 100% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
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United States | 1 | 4% |
Unknown | 23 | 96% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Student > Bachelor | 5 | 21% |
Student > Postgraduate | 3 | 13% |
Lecturer | 2 | 8% |
Lecturer > Senior Lecturer | 2 | 8% |
Student > Master | 2 | 8% |
Other | 6 | 25% |
Unknown | 4 | 17% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 8 | 33% |
Nursing and Health Professions | 7 | 29% |
Agricultural and Biological Sciences | 2 | 8% |
Energy | 1 | 4% |
Unknown | 6 | 25% |