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Article
Best-practice pain management in the emergency department: A cluster-randomised, controlled, intervention trial
Emergency Medicine Australasia
  • David McD Taylor, Austin Hospital, Melbourne, Victoria, Australia
  • Daniel M Fatovich, University of Western Australia
  • Daniel P Finucci, Prince of Wales Hospital
  • Jeremy Furyk, The Townsville Hospital, Townsville, Queensland, Australia
  • Sang-won Jin, Mater Adult Hospital, Brisbane, Queensland, Australia
  • Gerben Keijzers, Bond University
  • Setphen P J MacDonald, University of Western Australia
  • Hugh M A Mitenko, Bunbury Hospital, Bunbury,Western Australia
  • Joanna R Richardson, Austin Hospital, Melbourne
  • Joseph Y S Ting, Queensland University of Technology
  • Ogilvie N Thom, Princess Alexandra Hospital, Brisbane
  • Antony M Ugoni, The University ofMelbourne
  • James A Hughes, Queensland University of Technology
  • Nerolie F Bost, Griffith University
  • Meagan L Ward, Mercy Hospital for Women, Melbourne
  • Clinton R Gibbs, The Townsville Hospita
  • Ellen MacDonald, Royal Perth Hospital
  • Dane R Chalkley, Royal Prince Alfred, Sydney
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.

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2015 HERDC submission

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

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.

Citation Information
David McD Taylor, Daniel M Fatovich, Daniel P Finucci, Jeremy Furyk, et al.. "Best-practice pain management in the emergency department: A cluster-randomised, controlled, intervention trial" Emergency Medicine Australasia Vol. 27 Iss. 6 (2015) p. 549 - 557 ISSN: 1742-6731
Available at: http://works.bepress.com/gerben_keijzers/29/