title: Quality indicators for the assessment and management of pain in the emergency department: a systematic review.
abstract: BACKGROUND
  Evidence indicates that pain is undertreated in the emergency department (ED). The first step in improving the pain experience for ED patients is to accurately and systematically assess the actual care being provided. Identifying gaps in the assessment and treatment of pain and improving patient outcomes requires relevant, evidence-based performance measures.
  
  
  OBJECTIVE
  To systematically review the literature and identify quality indicators specific to the assessment and management of pain in the ED.
  
  
  METHODS
  Four major bibliographical databases were searched from January 1980 to December 2010, and relevant journals and conference proceedings were manually searched. Original research that described the development or collection of data on one or more quality indicators relevant to the assessment or management of pain in the ED was included.
  
  
  RESULTS
  The search identified 18,078 citations. Twenty-three articles were included: 15 observational (cohort) studies; three before-after studies; three audits; one quality indicator development study; and one survey. Methodological quality was moderate, with weaknesses in the reporting of study design and methodology. Twenty unique indicators were identified, with the majority (16 of 20) measuring care processes. Overall, 91% (21 of 23) of the studies reported indicators for the assessment or management of presenting pain, as opposed to procedural pain. Three of the studies included children; however, none of the indicators were developed specifically for a pediatric population.
  
  
  CONCLUSIONS
  Gaps in the existing literature include a lack of measures reflecting procedural pain, patient outcomes and the pediatric population. Future efforts should focus on developing indicators specific to these key areas.
authors.forename: Antonia Schirmer
authors.initials: AS
authors.lastname: Stang
authors.forename: Lisa
authors.initials: L
authors.lastname: Hartling
authors.forename: Cassandra
authors.initials: C
authors.lastname: Fera
authors.forename: David
authors.initials: D
authors.lastname: Johnson
authors.forename: Samina
authors.initials: S
authors.lastname: Ali
mesh_terms: D002648:Child; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D059408:Pain Management / Q000592:standards*; D010147:Pain Measurement / Q000592:standards*; D019984:Quality Indicators, Health Care