title: Best-practice pain management in the emergency department: A cluster-randomised, controlled, intervention trial.
abstract: OBJECTIVE
  We aimed to provide 'adequate analgesia' (which decreases the pain score by ≥2 and to <4 [0-10 scale]) and determine the effect on patient satisfaction.
  
  
  METHODS
  We undertook a multicentre, cluster-randomised, controlled, intervention trial in nine EDs. Patients with moderate pain (pain score of ≥4) were eligible for inclusion. The intervention was a range of educational activities to encourage staff to provide 'adequate analgesia'. It was introduced into five early intervention EDs between the 0 and 6 months time points and at four late intervention EDs between 3 and 6 months. At 0, 3 and 6 months, data were collected on demographics, pain scores, analgesia provided and pain management satisfaction 48 h post-discharge (6 point scale).
  
  
  RESULTS
  Overall, 1317 patients were enrolled. Logistic regression (controlling for site and other confounders) indicated that, between 0 and 3 months, satisfaction increased significantly at the early intervention EDs (OR 2.2, 95% CI 1.5 to 3.4 [P < 0.01]) but was stable at the control EDs (OR 0.8, 95% CI 0.5 to 1.3 [P = 0.35]). Pooling of data from all sites indicated that the proportion of patients very satisfied with their pain management increased from 42.9% immediately pre-intervention to 53.9% after 3 months of intervention (difference in proportions 11.0%, 95% CI 4.2 to 17.8 [P = 0.001]). Logistic regression of all data indicated that 'adequate analgesia' was significantly associated with patient satisfaction (OR 1.4, 95% CI 1.1 to 1.8 [P < 0.01]).
  
  
  CONCLUSIONS
  The 'adequate analgesia' intervention significantly improved patient satisfaction. It provides a simple and efficient target in the pursuit of best-practice ED pain management.
authors.affiliation: Emergency Department, Austin Hospital, Melbourne, Victoria, Australia.|Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: David McD
authors.initials: DM
authors.lastname: Taylor
authors.affiliation: Department of Emergency Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.|Department of Emergency Medicine, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Daniel M
authors.identifier: http://orcid.org/0000-0001-9414-6905
authors.initials: DM
authors.lastname: Fatovich
authors.affiliation: Emergency Department, Prince of Wales Hospital, Sydney, New South Wales, Australia.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Finucci
authors.affiliation: Emergency Department, The Townsville Hospital, Townsville, Queensland, Australia.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Furyk
authors.affiliation: Department of Emergency Medicine, Mater Adult Hospital, Brisbane, Queensland, Australia.
authors.forename: Sang-Won
authors.initials: SW
authors.lastname: Jin
authors.affiliation: Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia.|Department of Medicine, Griffith University, Brisbane, Queensland, Australia.|Department of Medicine, Bond University, Gold Coast, Queensland, Australia.
authors.forename: Gerben
authors.identifier: http://orcid.org/0000-0003-1100-4552
authors.initials: G
authors.lastname: Keijzers
authors.affiliation: Department of Emergency Medicine, University of Western Australia, Perth, Western Australia, Australia.|Emergency Department, Armadale Health Service, Perth, Western Australia, Australia.
authors.forename: Stephen Pj
authors.initials: SP
authors.lastname: Macdonald
authors.affiliation: Emergency Department, Bunbury Hospital, Bunbury, Western Australia, Australia.
authors.forename: Hugh Ma
authors.initials: HM
authors.lastname: Mitenko
authors.affiliation: Emergency Department, Austin Hospital, Melbourne, Victoria, Australia.
authors.forename: Joanna R
authors.initials: JR
authors.lastname: Richardson
authors.affiliation: Emergency Department, Mater Health Services, Brisbane, Queensland, Australia.|School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.
authors.forename: Joseph Ys
authors.initials: JY
authors.lastname: Ting
authors.affiliation: Department of Emergency Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
authors.forename: Ogilvie N
authors.initials: ON
authors.lastname: Thom
authors.affiliation: Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Antony M
authors.initials: AM
authors.lastname: Ugoni
authors.affiliation: Department of Emergency Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia.|Department of Medicine, Queensland University of Technology, Brisbane, Queensland, Australia.
authors.forename: James A
authors.initials: JA
authors.lastname: Hughes
authors.affiliation: Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia.|Department of Medicine, Griffith University, Brisbane, Queensland, Australia.
authors.forename: Nerolie
authors.initials: N
authors.lastname: Bost
authors.affiliation: Mercy Hospital for Women, Melbourne, Victoria, Australia.
authors.forename: Meagan L
authors.initials: ML
authors.lastname: Ward
authors.affiliation: Emergency Department, The Townsville Hospital, Townsville, Queensland, Australia.
authors.forename: Clinton R
authors.initials: CR
authors.lastname: Gibbs
authors.affiliation: Department of Emergency Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.
authors.forename: Ellen
authors.initials: E
authors.lastname: Macdonald
authors.affiliation: Emergency Department, Royal Prince Alfred, Sydney, New South Wales, Australia.
authors.forename: Dane R
authors.initials: DR
authors.lastname: Chalkley
keywords: analgesia; best practice; emergency department; pain