Quality of pain management in the emergency department: results of a multicentre prospective study.
OBJECTIVE
The purpose of this study was to evaluate pain management in a large sample of emergency departments (EDs) and identify potential corrective measures. METHOLOGY: A multicentre prospective study was performed in 50 EDs participating in a national quality improvement programme. The rate of inclusion was determined a priori in each ED. Patients were questioned about their pain and pain intensity was assessed by a visual analogue scale. A bivariate and a multivariate analysis were conducted to identify the criteria associated with inadequate pain management.


RESULTS
A total of 11 670 patients were included and 7265 patients reported pain on admission. On arrival, pain intensity was assessed in 90% of patients (44% experienced severe pain). However, reassessments were performed less often (48% on discharge). Fifty-one percent of patients received pain treatment. Intravenous morphine was used in only 9% of patients with severe pain. Initial treatment was provided within 60 min of admission to 74% of patients. Among patients who were assessed on discharge, 27% still had pain (8% with severe pain). Delay for pain management was significantly related to the ED volume, lack of triage nurses, patients' disorders and initial pain intensity.


CONCLUSIONS
This multicentre study conducted on a nationwide scale shows that pain relief can be improved in the ED. Pain intensity is not sufficiently reassessed, analgesics are underutilised, morphine sulfate is rarely used and delay in treatment is common. Reasons for inadequate analgesia were identified in order to identify relevant corrective measures to improve quality of pain management in the ED.
French National Hospital Audit and Expertise Agency, France.
Sophie
S
Guéant
Ariski
A
Taleb
Jocelyne
J
Borel-Kühner
Maxime
M
Cauterman
Maurice
M
Raphael
Guillaume
G
Nathan
Agnes
A
Ricard-Hibon
D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D015999:Multivariate Analysis; D010146:Pain / Q000503:physiopathology; D059408:Pain Management; D010147:Pain Measurement; D011446:Prospective Studies; D011787:Quality of Health Care; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult
D000700:Analgesics; D000701:Analgesics, Opioid; D009020:Morphine