An intervention to improve pain management in the pediatric emergency department.
OBJECTIVE
The objective of this study was to measure the impact of a structured intervention on pain management in a pediatric emergency department (ED).


METHODS
Data were prospectively collected from children presenting to an urban tertiary care pediatric ED before and after intervention. Data were collected on the rate and timeliness of analgesic administration, the assessment and reassessment of pain, periprocedural anesthesia, and patient satisfaction. The intervention was developed by a multidisciplinary committee composed of physicians, nurses, and child life specialists and was focused on correcting deficiencies identified before intervention data collection. It consisted of a policy defining pain, pain-appropriate analgesia, age-appropriate pain assessment, and adequate preprocedural and periprocedural analgesia. Implementation occurred through provider education, organizational changes, and patient empowerment.


RESULTS
One hundred two patients were enrolled during the preintervention period, and 109 were enrolled in the postintervention period. The percentage of patients in pain receiving any analgesic increased from 34% to 50%, an increase of 16% (95% confidence interval [CI], 1%-30%). The median time to medication administration decreased from 97 minutes to 57 minutes, a decrease of 40 minutes (95% CI, -84 to 4 minutes). The percentage of children receiving preprocedural analgesia increased from 10% to 62%, an increase of 52% (95% CI, 12%-74%). Reassessment of pain by physicians increased from 6% to 76%, an increase of 70% (95% CI, 59%-78%).


CONCLUSIONS
A structured intervention, tailored to pain management shortcomings commonly found in the pediatric ED, can lead to improvements in the treatment and prevention of pain in childhood emergencies.
Children's Hospital of Philadelphia, Philadelphia, PA 19146, USA. corwindj@gmail.com
Daniel J
DJ
Corwin
David O
DO
Kessler
Marc
M
Auerbach
Ana
A
Liang
George
G
Kristinsson
D000293:Adolescent; D000367:Age Factors; D000698:Analgesia / Q000379:methods; D000758:Anesthesia / Q000379:methods; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement / Q000379:methods; D017060:Patient Satisfaction; D016730:Program Development; D011446:Prospective Studies; D014481:United States; D055815:Young Adult