title: A standardized pain management protocol improves timeliness of analgesia among emergency department patients with renal colic.
abstract: BACKGROUND
  Kidney stones are a common, and extremely painful, cause of emergency department (ED) visits. Pain management is a critical component of high-quality patient care. A pilot study at our institution found that only 69% of ED patients with renal colic had evidence of clinically significant analgesia.
  
  
  OBJECTIVE
  In response to these findings, we evaluated the impact of a formalized pain management protocol on timeliness of analgesia among ED patients with renal colic.
  
  
  METHODS
  Using a before and after study design, adult ED patients with renal colic were eligible. In the prospective arm, patients were treated with ketorolac, 30 mg intravenous, and morphine, 0.05-0.1 mg/kg intravenous, according to a standardized protocol. Results were compared with a retrospective chart review of eligible patients treated during a similar preprotocol period.
  
  
  RESULTS
  Implementation of the protocol resulted in a significant reduction in time to effective analgesia (72 ± 63 vs 37 ± 42 minutes, P = .003). The protocol did not result in any increase in adverse effects.
  
  
  CONCLUSIONS
  Implementation of a standardized pain management protocol among ED patients with renal colic resulted in a marked improvement in quality of care as evidenced by a 49% reduction in time to effective analgesia.
authors.affiliation: Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Steinberg
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Nangia
authors.forename: Kevin
authors.initials: K
authors.lastname: Curtis
mesh_terms: D000328:Adult; D000698:Analgesia / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D002985:Clinical Protocols / Q000592:standards*; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006801:Humans; D020910:Ketorolac / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D010043:Outcome and Process Assessment, Health Care; D010146:Pain / Q000188:drug therapy* / Q000209:etiology*; D011446:Prospective Studies; D056844:Renal Colic / Q000150:complications*; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D009020:Morphine; D020910:Ketorolac