title: Pain management in Australian emergency departments: current practice, enablers, barriers and future directions.
abstract: OBJECTIVE
  To explore current pain management practice in Australian EDs and identify enablers and barriers for best-practice pain management.
  
  
  METHODS
  Five focus groups and two in-depth interviews were held with ED clinical staff (n= 47) from six hospitals in three states. Participants were asked open-ended questions to determine current pain management practices, enablers and barriers to implementing best-practice pain management, and understand change in practice within the ED setting.
  
  
  RESULTS
  Emergency department staff identified a gap between evidence-based pain management recommendations and everyday practice. Perceived barriers to improving pain management included a lack of time and resources, a greater number of urgent and serious presentations that place pain management as a lower priority, organizational protocols and legislative issues. All groups noted difficulty in applying pain management guidelines in the context of competing priorities in the challenging ED environment. A culture of learning clinical practice from respected senior staff and peers was perceived to be a key enabler. Participants consistently expressed the view that evidence-based practice improvement should be championed by senior clinical staff, and that evidence to demonstrate the benefits of change must be presented to support the need for change.
  
  
  CONCLUSIONS
  Effective and sustainable system change requires a strategy that is initiated within the ED, targets opinion leaders, is supported by evidence, and engages all levels of ED staff.
authors.affiliation: Effective Practice Program, National Health and Medical Research Council, National Institute of Clinical Studies, Melbourne, VIC 3001, Australia. scott.bennetts@nhmrc.gov.au
authors.forename: Scott
authors.initials: S
authors.lastname: Bennetts
authors.forename: Evylyn
authors.initials: E
authors.lastname: Campbell-Brophy
authors.forename: Susan
authors.initials: S
authors.lastname: Huckson
authors.forename: Steven
authors.initials: S
authors.lastname: Doherty
mesh_terms: D001315:Australia; D004636:Emergency Service, Hospital; D055317:Evidence-Based Practice; D017144:Focus Groups; D006801:Humans; D007857:Leadership; D008505:Medical Staff, Hospital / Q000523:psychology; D015279:Organizational Culture; D009936:Organizational Innovation; D059408:Pain Management / Q000592:standards; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care / Q000379:methods; D011795:Surveys and Questionnaires