title: Impact of a pilot team on patients' pain reduction and satisfaction in an emergency department: A before-and-after observational study.
abstract: BACKGROUND
  Pain management and patient satisfaction were targeted in the emergency department of a Paris university hospital. In 1999, 77.0% of patients complained of pain on arrival and more than half of patients did not experience pain relief at discharge. The purpose of the study was to evaluate the outcomes of the implementation of a team piloting pain management on pain reduction and pain care satisfaction.
  
  
  METHODS
  Two cross-sectional surveys (04/10/1999 to 19/10/1999 and 03/04/2007 to 18/04/2007) were conducted before and after a team piloting pain management was deployed in the emergency department. Consecutive patients age 18 years and older who visited the department suffering from pain were given structured questionnaires that validated scales scoring pain upon arrival and at discharge. Patients' files were analyzed using structured forms. The parameters associated with pain reduction and patient satisfaction were sought.
  
  
  RESULTS
  In 2007, 65.0% of patients had their pain relieved vs. 35.1% in 1999 (P<0.001); 60.2% were satisfied with the pain care received vs. 39.8%. Pain management (e.g. waiting time ≤ 20 min: 47.6% vs. 20.8%; interventions on pain before the physician's examination: 63.0% vs. 13.8%; and pain reassessment after intervention: 13.8% vs. 4.5%) improved. Both pain reduction and patient satisfaction were significantly associated with intervention before the physician's examination. Pain reduction was independently and positively associated with time of survey, triage level (depending on the severity of their condition), pain intensity on arrival, and negatively associated with discharge without hospitalization. Satisfaction was independently and positively associated with waiting time before examination (0-20 min) and the absence of procedural pain.
  
  
  CONCLUSIONS
  The implementation of a team piloting pain management seemed to have had positive effects on pain management in the emergency department. However, respectively, 56.2% and 39.8% of patients remained without pain relief and dissatisfied with pain management at the end of their visit.
authors.affiliation: Public health unit: risk management and quality of care, Paris Centre University Hospital Group, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
authors.forename: V
authors.initials: V
authors.lastname: Kone
authors.affiliation: Emergency department, Paris Centre University Hospital, AP-HP, 75014 Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Lecomte
authors.affiliation: Public health unit: risk management and quality of care, Paris Centre University Hospital Group, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
authors.forename: D
authors.initials: D
authors.lastname: Randriamanana
authors.affiliation: Emergency department, Paris Centre University Hospital, AP-HP, 75014 Paris, France; Department of public health, faculty of medicine, Paris Descartes University, Sorbonne Paris Cité, 75006 Paris, France.
authors.forename: J-L
authors.initials: JL
authors.lastname: Pourriat
authors.affiliation: Emergency department, Paris Centre University Hospital, AP-HP, 75014 Paris, France; Department of public health, faculty of medicine, Paris Descartes University, Sorbonne Paris Cité, 75006 Paris, France.
authors.forename: Y-E
authors.initials: YE
authors.lastname: Claessens
authors.affiliation: Public health unit: risk management and quality of care, Paris Centre University Hospital Group, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Department of public health, faculty of medicine, Paris Descartes University, Sorbonne Paris Cité, 75006 Paris, France; Research unit (Inserm U1153) methods team, methods of therapeutic evaluation of chronic diseases, research center epidemiology and biostatistics, Sorbonne Paris Cité, 75004 Paris, France. Electronic address: gwenaelle.vidal-trecan@parisdescartes.fr.
authors.forename: G
authors.initials: G
authors.lastname: Vidal-Trecan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010297:Paris; D010348:Patient Care Team / Q000458:organization & administration*; D010351:Patient Discharge; D017060:Patient Satisfaction; D011795:Surveys and Questionnaires; D014218:Triage / Q000458:organization & administration*; D000078329:Workforce; D055815:Young Adult
keywords: Adultes; Adults; Douleur; Emergency departments; Hôpital universitaire; Pain; Pain reduction; Patient satisfaction; Satisfaction des patients; Service d’urgence; University hospital