1
|
Soldatenkova A, Calabrese A, Levialdi Ghiron N, Tiburzi L. Emergency department performance assessment using administrative data: A managerial framework. PLoS One 2023; 18:e0293401. [PMID: 37917787 PMCID: PMC10621983 DOI: 10.1371/journal.pone.0293401] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/11/2023] [Indexed: 11/04/2023] Open
Abstract
Administrative data play an important role in performance monitoring of healthcare providers. Nonetheless, little attention has been given so far to the emergency department (ED) evaluation. In addition, most of existing research focuses on a single core ED function, such as treatment or triage, thus providing a limited picture of performance. The goal of this study is to harness the value of routinely produced records proposing a framework for multidimensional performance evaluation of EDs able to support internal decision stakeholders in managing operations. Starting with the overview of administrative data, and the definition of the desired framework's characteristics from the perspective of decision stakeholders, a review of the academic literature on ED performance measures and indicators is conducted. A performance measurement framework is designed using 224 ED performance metrics (measures and indicators) satisfying established selection criteria. Real-world feedback on the framework is obtained through expert interviews. Metrics in the proposed ED performance measurement framework are arranged along three dimensions: performance (quality of care, time-efficiency, throughput), analysis unit (physician, disease etc.), and time-period (quarter, year, etc.). The framework has been judged as "clear and intuitive", "useful for planning", able to "reveal inefficiencies in care process" and "transform existing data into decision support information" by the key ED decision stakeholders of a teaching hospital. Administrative data can be a new cornerstone for health care operation management. A framework of ED-specific indicators based on administrative data enables multi-dimensional performance assessment in a timely and cost-effective manner, an essential requirement for nowadays resource-constrained hospitals. Moreover, such a framework can support different stakeholders' decision making as it allows the creation of a customized metrics sets for performance analysis with the desired granularity.
Collapse
Affiliation(s)
- Anastasiia Soldatenkova
- Dipartimento di Ingegneria dell’Impresa Mario Lucertini, Università degli Studi di Roma “Tor Vergata”, Rome, Italy
| | - Armando Calabrese
- Dipartimento di Ingegneria dell’Impresa Mario Lucertini, Università degli Studi di Roma “Tor Vergata”, Rome, Italy
| | - Nathan Levialdi Ghiron
- Dipartimento di Ingegneria dell’Impresa Mario Lucertini, Università degli Studi di Roma “Tor Vergata”, Rome, Italy
| | - Luigi Tiburzi
- Dipartimento di Ingegneria dell’Impresa Mario Lucertini, Università degli Studi di Roma “Tor Vergata”, Rome, Italy
| |
Collapse
|
2
|
Mohanty CR, Varghese JJ, Panda R, Sahoo S, Mishra TS, Radhakrishnan RV, Topno N, Hansda U, Shaji IM, Behera SHP. Ultrasound-guided selective peripheral nerve block compared with the sub-dissociative dose of ketamine for analgesia in patients with extremity injuries. Am J Emerg Med 2023; 63:94-101. [PMID: 36332503 DOI: 10.1016/j.ajem.2022.10.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/19/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022] Open
Abstract
STUDY OBJECTIVE To compare the analgesic efficacy of ultrasound-guided selective peripheral nerve block (PNB) and sub-dissociative dose ketamine (SDK) for management of acute pain in patients with extremity injuries presenting to the emergency department (ED). METHODS This prospective, open-label randomized clinical trial was conducted in the ED of a tertiary care Institute. The patients were provided with either ultrasound-guided selective PNB or SDK. The primary outcome was a reduction in pain in numerical rating scale (NRS) by at least 3 points without rescue analgesia. The secondary outcomes were the need for rescue analgesia, adverse events, and patient satisfaction on either arm. RESULTS A total of 111 patients with isolated traumatic extremity injuries were included in the final analysis. The NRS score was significantly lower in the PNB group compared to the SDK group at 30, 60,120, 180-, and 240-min post-intervention [group ∼ time interaction, F (5, 647) = 21.53, p ≤ 0.001]. All the patients in the PNB group exhibited primary outcome (NRS ≥3 reductions) at 30 min post-intervention compared with 36 (65%) in the SDK group [-1.02(-1.422,0.622)]. Rescue analgesia was required in 10 (18%) patients in the SDK group compared to none in the PNB group [0.663(0.277,1.050)]. The decrease in NRS score from baseline at 30 min was significantly higher in PNB groups compared to the SDK group [-2.166(-2.640, -1.692)]. The most common side effect reported in the SDK group was dizziness 35(64%), followed by nausea 15(27%). None of the patients in the PNB group reported any complications. Patient satisfaction was higher in the PNB group than SDK group. CONCLUSION The study provides evidence that ultrasound-guided PNB is superior to SDK in terms of its analgesic efficacy in the management of acute pain due to extremity injuries and is associated with higher patient satisfaction. The need for rescue analgesia was significantly less in the PNB group. SDK was associated with a high incidence of dizziness and nausea.
Collapse
Affiliation(s)
- Chitta Ranjan Mohanty
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
| | - Jithin Jacob Varghese
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Ritesh Panda
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sangeeta Sahoo
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | | | | | - Nitish Topno
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Upendra Hansda
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Ijas Muhammed Shaji
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Shri Hari Priya Behera
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India; Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| |
Collapse
|
3
|
Blum CA, Velly L, Brochet C, Ziegler F, Tavolacci MP, Hausfater P, Lvovschi VE. Relevance of cortisol and copeptin blood concentration changes in an experimental pain model. Sci Rep 2022; 12:4767. [PMID: 35306524 PMCID: PMC8934351 DOI: 10.1038/s41598-022-08657-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 03/03/2022] [Indexed: 01/21/2023] Open
Abstract
The effect of pain and analgesics on stress biomarkers is not well studied. We evaluated the effect of acute pain and analgesics on serum cortisol and copeptin in an experimental pain model in healthy volunteers. Healthy volunteers presented at 8 a.m. for an experimental pain stimulation. Cortisol and copeptin levels were measured before, during and after electrophysiological stimulation, first before and then during opioid delivery. Difference in biomarker levels compared to baseline levels was calculated, and potential influencing factors were evaluated by linear regression analysis. Cortisol decreased by 13% during the 10 min of rest at baseline, but copeptin did not change significantly. Cortisol had a median decrease of −24% or −83 nmol/l (−44 to −124 nmol/l, p = 0.0002) during the electrophysiological stimulation training session, while the median difference for copeptin was −22% or −1.01 pmol/l (−2.35 to 0.08 pmol/l, p = 0.0003). After administration of opioids, cortisol did not decrease but increased by 3% (p = 0.043), indicating an increasing opioids effect on cortisol. This effect was not visible for copeptin (median change −0.003 pmol/l (−0.50 to 0.24), p = 0.45). In this experimental pain model performed in the morning, moderate pain did not have a relevant effect on cortisol or copeptin levels, whereas opioids led to a discrete peak of cortisol. Clinicaltrials.gov identifier: NCT01975753 (registered on November 5, 2013, before start of recruitment).
Collapse
|
4
|
Hartshorn S, Durnin S, Lyttle MD, Barrett M. Pain management in children and young adults with minor injury in emergency departments in the UK and Ireland: a PERUKI service evaluation. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2021-001273. [PMID: 36053599 PMCID: PMC8943777 DOI: 10.1136/bmjpo-2021-001273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 03/03/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Management of acute pain should commence at the earliest opportunity, as it has many short-term and long-term consequences. A research priority of Paediatric Emergency Research in the UK and Ireland (PERUKI) was to examine paediatric pain practices. OBJECTIVE To describe the outcomes for paediatric pain management of minor injuries presenting to emergency departments (EDs) across PERUKI. METHODS A retrospective service evaluation was performed over a 7-day period in late 2016/early 2017 across PERUKI sites, and analysis performed using an adapted Donabedian framework. Patients under 16 years presenting with minor trauma were eligible, and data were collected on prehospital management, pain assessment, analgesia administered and injury diagnosed. RESULTS Thirty-one sites submitted data on 3888 patients. There were 111 missed cases (missed rate 3.6%). The most common injuries were sprains, lacerations, contusions/abrasions and fractures. Documentation of receiving analgesia before arrival in ED occurred in 21% of patients (n=818). A pain assessment was documented in 57.5% of patients (n=2235) during their ED visit, and 3.5% of patients had their pain reassessed (n=138). Of the patients who presented in severe pain (pain score 7-10 or rated severe), 11% were reassessed. Site variability of initial pain assessment ranged from 1.4% to 100% (median 62%). The characteristics of the top quartile performing centres against the bottom quartile performing centres based on completion rate of initial pain scores were identified. CONCLUSION Pain assessment was documented in under 60% of children with minor injury, re-assessment of pain was almost completely absent, data and outcomes were missing in a substantial volume of patients, indicating that pain management and the associated outcomes have not been adequately addressed and prioritised within existing network structures and processes.
Collapse
Affiliation(s)
- Stuart Hartshorn
- Paediatric Emergency Medicine, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK .,Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Sheena Durnin
- Paediatric Emergency Medicine, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,Paediatric Emergency Medicine, Children's Health Ireland at Tallaght, Dublin, Ireland
| | - Mark D Lyttle
- Paediatric Emergency Medicine, Bristol Royal Hospital for Children, Bristol, UK.,Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Michael Barrett
- Paediatric Emergency Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland.,Women's and Children's Health, University College Dublin, Dublin, Ireland
| | | |
Collapse
|
5
|
Hämäläinen J, Kvist T, Kankkunen P. Acute Pain Assessment Inadequacy in the Emergency Department: Patients' Perspective. J Patient Exp 2022; 9:23743735211049677. [PMID: 35005219 PMCID: PMC8733361 DOI: 10.1177/23743735211049677] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
For many patients, acute pain is a common cause to seek treatment in an Emergency Department (ED). An inadequate assessment could cause inappropriate pain management. The aim of this study was to describe and explain patients’ perceptions of acute pain assessment in the Emergency Department. The data were collected from ED patients (n = 114). Patients reported that nurses were asking about intensity of pain at rest, but only 52% during movement. According to the patients, the most common tools to assess acute pain were the verbal rating scale (VRS; 54% of patients), numerical rating scale (NRS; 28% of patients), and visual analogue scale (VAS; 9.7% of patients). Over twenty per cent of patients stated that ED nurses did not ask about the intensity of pain after analgesic administration. Twenty-four per cent of the patients were not pleased with nursing pain assessment in the ED. The assessment of acute pain is still inadequate in the ED. Therefore, ED nurses need to be more attentive to systematic acute pain management of patients in the ED.
Collapse
Affiliation(s)
- Jenni Hämäläinen
- Department of Nursing Science, Finland University of Eastern Finland, Kuopio, Finland
| | - Tarja Kvist
- Department of Nursing Science, Finland University of Eastern Finland, Kuopio, Finland
| | - Päivi Kankkunen
- Department of Nursing Science, Finland University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
6
|
Poggiali E, De Iaco F. The pain in the Emergency Department: Choosing and treating wisely before and during the COVID-19 era. EMERGENCY CARE JOURNAL 2021. [DOI: 10.4081/ecj.2021.9903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pain is a frequent reason for referral to the Emergency Department (ED). Adequate management of pain is a moral and ethical imperative. If not correctly treated, acute pain can cause physical and psychological complications, and become chronic with severe consequences such as anxiety, depression, and social isolation. As consequence, emergency clinicians should treat pain as soon as possible, avoiding delays even in case of acute abdominal pain. Pain management is particularly complex in the elderly and emergency clinicians should always consider AGS Beers criteria ® to avoid inappropriate medications, severe side-effects, and drug-drug interactions. Pain is also a common cause of delirium in older patients. The SARS CoV-2 infection not only can cause acute pain, but also exacerbate chronic pain, particularly in the elderly, who are at high risk to be infected. Looking at all this evidence, emergency clinicians should treat pain with different strategies according to their experience and cultural background, making the right choice for each patient. This work is a critical review of the pain management in the ED, with a particular attention on the effects of COVID-19 in the EDs. We conducted a systematic search of the following databases: PubMed, Google Scholar, Science Direct, Medline from 2000 to 2020, using the keywords of “pain”, “emergency”, “COVID19”, “elderly”, “palliative care”, “ketamine”, “dexmedetomidine”, and “post-traumatic stress disorder”. The aim of this review is to help emergency clinicians to correctly manage pain in the ED with a new point of view regarding the pain management in COVID-19 patients.
Collapse
|
7
|
Bond C, Westafer L, Challen K, Milne WK. Hot off the press: the RAMPED trial-methoxyflurane for analgesia in the emergency department. Acad Emerg Med 2021; 28:1179-1182. [PMID: 33772948 DOI: 10.1111/acem.14257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Kirsty Challen
- ScHARR, Regent Court University of Sheffield Sheffield UK
| | | |
Collapse
|
8
|
An observational cohort study comparing ibuprofen and oxycodone in children with fractures. PLoS One 2021; 16:e0257021. [PMID: 34499688 PMCID: PMC8428788 DOI: 10.1371/journal.pone.0257021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 08/22/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To compare the effectiveness and safety of prescribing ibuprofen and oxycodone for at-home management of children's fracture pain. METHODS A prospective observational cohort was conducted at the Stollery Children's Hospital pediatric emergency department (June 2010-July 2014). Children aged 4-16 years with an isolated fracture discharged home with advice to use either ibuprofen or oxycodone were recruited. RESULTS A cohort of 329 children (n = 217 ibuprofen, n = 112 oxycodone) were included. Mean age was 11.1 years (SD 3.5); 68% (223/329) were male. Fracture distribution included 80.5% (264/329) upper limb with 34.3% (113/329) requiring fracture reduction. The mean reduction in Faces Pain Score-Revised score (maximum pain-post-treatment pain) for Day 1 was 3.6 (SD 1.9) (ibuprofen) and 3.8 (SD 2.1) (oxycodone) (p = 0.50); Day 2 was 3.6 (SD 1.8) (ibuprofen) and 3.7 (SD 1.6) (oxycodone) (p = 0.56); Day 3 was 3.7 (SD 1.7) (ibuprofen) and 3.3 (SD 1.7) (oxycodone) (p = 0.24). Children prescribed ibuprofen (51.2%, 109/213) experienced less adverse events compared to those prescribed oxycodone (70.5% 79/112) on Day 1 (p = 0.001). Children prescribed ibuprofen (71.8%, 150/209) had their function (eat, play, school, sleep) affected less than those prescribed oxycodone (83.0%, 93/112) (p = 0.03) on Day 1. CONCLUSION Children prescribed ibuprofen or oxycodone experienced similar analgesic effectiveness for at-home fracture pain. Oxycodone prescribing was associated with more adverse events and negatively impacted function. Oxycodone use does not appear to confer any benefit over ibuprofen for pain relief and has a negative adverse effect profile. Ibuprofen appears to be a safe option for fracture-related pain.
Collapse
|
9
|
Hughes JA, Chiu J, Brown NJ, Hills A, Allwood B, Chu K. The documentation of pain intensity and its influences on care in the emergency department. Int Emerg Nurs 2021; 57:101015. [PMID: 34166989 DOI: 10.1016/j.ienj.2021.101015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/19/2021] [Accepted: 04/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Assessment and reassessment of self reported pain intensity scores form the basis of acute pain care in the emergency deprtment (ED), however are frequently undocumented. The effects of not documenting pain assessments on time to first analgesic medication (TTA) and ED length of stay (EDLOS) are unknown. METHODS This is a retrospective cross-sectional study to investigate the association between documented evidence of pain intensity scores, TTA and EDLOS in the ED. It also examined the factors associated with the documentation of pain intensity scores. Univariate and multivariable modelling was used on a random sample of presentations. RESULTS There were no statistically significant associations between the documented evidence of pain intensity scores and TTA or EDLOS. Modelling suggests that patients were less likely to have documented evidence of pain intensity scores if they were male, were streamed to the fast-track treatment area, had a lower burden of co-morbidities, or when the general departmental workload was increased. CONCLUSIONS The documentation of pain intensity scores was not associated with TTA or EDLOS. Some demographic, illness and workload factors are associated with the lack of pain intensity score documentation, however, the effect on patients outcomes needs further investigation.
Collapse
Affiliation(s)
- James A Hughes
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia; School of Nursing, Queensland University of Technology, Brisbane, Australia.
| | - Jacqui Chiu
- Facility of Medicine, The University of Queensland, Brisbane, Australia
| | - Nathan J Brown
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia; Facility of Medicine, The University of Queensland, Brisbane, Australia
| | - Angela Hills
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Brandon Allwood
- School of Nursing, Queensland University of Technology, Brisbane, Australia; Emergency Department, Mater Public Hospital, Brisbane, Australia
| | - Kevin Chu
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia; Facility of Medicine, The University of Queensland, Brisbane, Australia
| |
Collapse
|
10
|
Hughes JA, Alexander KE, Spencer L, Yates P. Factors associated with time to first analgesic medication in the emergency department. J Clin Nurs 2021; 30:1973-1989. [PMID: 33829583 DOI: 10.1111/jocn.15750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 02/08/2021] [Accepted: 02/25/2021] [Indexed: 11/30/2022]
Abstract
AIM AND OBJECTIVE To examine the factors associated with time to first analgesic medication in the emergency department. BACKGROUND Pain is the most common symptom presenting to the emergency department, and the time taken to deliver analgesic medication is a common outcome measure. Factors associated with time to first analgesic medication are likely to be multifaceted, but currently poorly described. DESIGN Retrospective cohort study. METHODS Cox proportional hazards regression modelling was undertaken to evaluate the associations between person, environment, health and illness variables within Symptom Management Theory and time to first analgesic medication in a sample of adult patients presenting with moderate-to-severe pain to an emergency department over twelve months. This study was completed in line with the STROBE statement. RESULTS 383 patients were included in the study, 290 (75.92%) of these patients received an analgesic medication in a median time of 45 minutes (interquartile range, 70 minutes). A model containing nine explanatory variables associated with time to first analgesic medication was identified. These nine variables (employment status, discharge location, triage score, Charlson score, arrival pain score, socio-economic status, first location, daily total treatment time and patient time to be seen) represent all of the domains of the Symptom Management Theory. CONCLUSIONS Person, environment, health and illness factors are associated with the time taken to deliver analgesic medication to those in pain in the emergency department. This study demonstrates the complexity of factors associated with pain care and the applicability of Symptom Management Theory to pain care in the emergency department. RELEVANCE TO CLINICAL PRACTICE Identifying a model of factors that are associated with the time in which the most common symptom presenting to the emergency department is treated allows for targeted interventions to groups likely to receive poor care and a framework for its evaluation.
Collapse
Affiliation(s)
- James A Hughes
- School of Nursing, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Brisbane, Qld., Australia.,Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Butterfield Street Herston, Herston, Qld., Australia
| | - Kimberly E Alexander
- School of Nursing, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Brisbane, Qld., Australia.,St Vincent's Private Hospital Northside, Chermside, Qld., Australia
| | - Lyndall Spencer
- Emergency Department, Princess Alexandra Hospital, Ipswich Road Woolloongabba, Woolloongabba, Qld., Australia
| | - Patsy Yates
- School of Nursing, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Brisbane, Qld., Australia
| |
Collapse
|
11
|
Glarcher M, Kundt FS, Meissner W, Osterbrink J. Quality Indicators (QI) of Acute Pain after Surgery in European Countries. Pain Manag Nurs 2021; 22:730-739. [PMID: 33642197 DOI: 10.1016/j.pmn.2021.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 01/04/2021] [Accepted: 01/24/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES It is common practice to use pain quality indicators (QI) to accurately assess the medical care situation of patients. This literature review identifies the status quo of acute pain QI among adult inpatients. DATA SOURCES Studies published in English or German were identified using a systematic search on CINAHL, Cochrane Library, PubMed, Web of Science, and Google Scholar from 01/2007 to 02/2018. Additional pain management journals, conference proceedings, and websites of health organizations and pain societies were manually screened. Studies about postoperative pain in adults (≥18 years) during inpatient stay after all types of surgery in Europe were included in this review. REVIEW/ANALYSIS METHODS The identified study results were categorized into structural, process, and outcome indicators based on Donabedian's framework of evaluating care quality. RESULTS The search identified 319 citations, of which 20 studies used structure, process, and outcome data including 180,988 patients and 1,970 health care professionals to gain insight into the quality of acute pain management. Overall, 80% used patient surveys to collect data. National data on pain management are reported in five European studies (France [2], the Netherlands, Spain, and Austria). CONCLUSIONS European studies comprehensively comparing acute pain management results are currently missing. Thus, this report highlights the need to develop consensus-based quality indicators in management of acute pain, which take into account both the methodologic quality and the relevance to clinical practice.
Collapse
Affiliation(s)
- Manela Glarcher
- Paracelsus Medical University, Institute of Nursing Science and Practice, Austria.
| | - Firuzan Sari Kundt
- Paracelsus Medical University, Institute of Nursing Science and Practice, Austria
| | - Winfried Meissner
- Anesthesiology and Intensive Care, Head of Pain Unit, Head of Palliative Care Unit, Jena University Hospital, Germany
| | - Jürgen Osterbrink
- Head of Institute of Nursing Science and Practice & Director WHO Collaborating Centre for Nursing, Austria
| |
Collapse
|
12
|
Eucker SA, Manandhar P, Arulraja K, Agnihotri D, Pollack CV, Freiermuth C. Higher daily pain severity after emergency department visits is associated with lower return-to-work rates. Am J Emerg Med 2021; 45:48-53. [PMID: 33657503 DOI: 10.1016/j.ajem.2021.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pain can impair functional status, including a patient's ability to return to work. The purpose of this study was to determine whether there was an association between pain levels and return-to-work status during the first 4 days post-ED discharge in ED patients seen for undifferentiated acute pain. METHODS This secondary analysis of data from the Acute Management of Pain from the Emergency Department (AMPED) registry included patients who reported working either full-time or part-time. We used Cox regression models to examine the association between daily self-reported minimum and maximum pain scores and first return to work. We used repeated measures logistic regression models to examine the association between daily minimum and maximum pain scores and daily return-to-work status. RESULTS Of the 610 employed patients, 481 (78.9%) were employed full-time and 129 (21.1%) part-time. The average delay in returning to work after ED visit was 2.4 days. For all models, higher minimum and maximum daily pain scores predicted lower daily return-to-work rates in the first four days post-ED discharge. The adjusted hazards ratios for first return to work were 0.91 (0.87, 0.96) and 0.93 (0.89, 0.97), while the adjusted odds ratios for daily return-to-work status were 0.80 (0.75, 0.85) and 0.88 (0.83, 0.93) for every one-point increase in minimum and maximum pain scores, respectively. CONCLUSION Higher daily pain severity is associated with decreased return-to-work after ED visits for acute pain, highlighting the importance of adequate discharge pain management from the ED.
Collapse
Affiliation(s)
- Stephanie A Eucker
- Duke University, Department of Surgery, Division of Emergency Medicine, United States of America.
| | | | - Kami Arulraja
- Duke University, Department of Surgery, Division of Emergency Medicine, United States of America
| | - Deepti Agnihotri
- Duke University, Department of Surgery, Division of Emergency Medicine, United States of America
| | - Charles V Pollack
- University of Mississippi School of Medicine, Department of Emergency Medicine, United States of America
| | - Caroline Freiermuth
- University of Cincinnati, Department of Emergency Medicine, United States of America
| |
Collapse
|
13
|
Brichko L, Gaddam R, Roman C, O’Reilly G, Luckhoff C, Jennings P, Smit DV, Cameron P, Mitra B. Rapid Administration of Methoxyflurane to Patients in the Emergency Department (RAMPED) Study: A Randomized Controlled Trial of Methoxyflurane Versus Standard Care. Acad Emerg Med 2021; 28:164-171. [PMID: 32989888 DOI: 10.1111/acem.14144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/04/2020] [Accepted: 09/16/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The objective was to evaluate the effectiveness of methoxyflurane versus standard care for the initial management of severe pain among adult emergency department (ED) patients. METHODS This randomized parallel-group open-label phase IV trial of methoxyflurane was conducted in a tertiary hospital ED setting in Australia. Inclusion criteria required adult patients to have an initial pain score ≥ 8 on the 11-point Numerical Rating Scale (NRS). Patients were randomized 1:1 to receive either inhaled methoxyflurane (3 mL) or standard analgesic treatment at ED triage. The primary outcome was the proportion of patients achieving clinically substantial pain reduction, defined as a ≥50% drop in the pain score at 30 minutes. Secondary outcomes included the pain score at multiple time points (15, 30, 60, 90 minutes) and the difference in the proportion of patients achieving a >2-point reduction on the NRS. RESULTS There were 120 patients randomized and analyzed between September 4, 2019, and January 16, 2020. The primary outcome was achieved in six (10%) patients in the methoxyflurane arm and three (5%) in the standard care arm (p = 0.49). A higher proportion of patients in the methoxyflurane arm reported a >2-point drop on the NRS at all time points (17% vs. 5% at 15 minutes, 25% vs. 9% at 30 minutes, 30% vs. 10% at 60 minutes, and 33% vs. 13% at 90 minutes). Methoxyflurane use was also associated with lower median pain scores at all time points. CONCLUSION Initial management with inhaled methoxyflurane in the ED did not achieve the prespecified substantial reduction in pain, but was associated with clinically significant lower pain scores compared to standard therapy.
Collapse
Affiliation(s)
- Lisa Brichko
- From Emergency and Trauma Centre Alfred Health MelbourneAustralia
- School of Public Health & Preventive Medicine Monash MelbourneAustralia
- Emergency Department Cabrini Hospital MelbourneAustralia
| | - Ravali Gaddam
- From Emergency and Trauma Centre Alfred Health MelbourneAustralia
- Central Clinical School Monash MelbourneAustralia
| | - Cristina Roman
- From Emergency and Trauma Centre Alfred Health MelbourneAustralia
- Pharmacy Department Alfred Health MelbourneAustralia
- Centre for Medication Use and Safety Faculty of Pharmacy and Pharmaceutical Sciences Monash MelbourneAustralia
| | - Gerard O’Reilly
- From Emergency and Trauma Centre Alfred Health MelbourneAustralia
- School of Public Health & Preventive Medicine Monash MelbourneAustralia
- and National Trauma and Research Institute Alfred Health MelbourneAustralia
| | - Carl Luckhoff
- From Emergency and Trauma Centre Alfred Health MelbourneAustralia
| | - Paul Jennings
- School of Public Health & Preventive Medicine Monash MelbourneAustralia
- and Ambulance Victoria Melbourne Australia
- and Department of Paramedicine Monash University MelbourneAustralia
| | - De Villiers Smit
- From Emergency and Trauma Centre Alfred Health MelbourneAustralia
- School of Public Health & Preventive Medicine Monash MelbourneAustralia
- and National Trauma and Research Institute Alfred Health MelbourneAustralia
| | - Peter Cameron
- From Emergency and Trauma Centre Alfred Health MelbourneAustralia
- School of Public Health & Preventive Medicine Monash MelbourneAustralia
| | - Biswadev Mitra
- From Emergency and Trauma Centre Alfred Health MelbourneAustralia
- School of Public Health & Preventive Medicine Monash MelbourneAustralia
- and National Trauma and Research Institute Alfred Health MelbourneAustralia
| |
Collapse
|
14
|
Woolner V, Ahluwalia R, Lum H, Beane K, Avelino J, Chartier LB. Improving timely analgesia administration for musculoskeletal pain in the emergency department. BMJ Open Qual 2020; 9:bmjoq-2019-000797. [PMID: 31986116 PMCID: PMC7011892 DOI: 10.1136/bmjoq-2019-000797] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/05/2019] [Accepted: 12/10/2019] [Indexed: 12/23/2022] Open
Abstract
Delays to adequate analgesia result in worse patient care, decreased patient and provider satisfaction and increased patient complaints. The leading presenting symptom to emergency departments (EDs) is pain, with approximately 34 000 such patients per year in our academic hospital ED and 3300 visits specific for musculoskeletal (MSK) injuries. Our aim was to reduce the time-to-analgesia (TTA; time from patient triage to receipt of analgesia) for patients with MSK pain in our ED by 55% (to under 60 min) in 9 months' time (May 2018). Our outcome measures included mean TTA and ED length of stay (LOS). Process measures included rates of analgesia administration and of use of medical directives. We obtained weekly data capture for Statistical Process Control (SPC) charts, as well as Mann-Whitney U tests for before-and-after evaluation. We performed wide stakeholder engagement, root cause analyses and created a Pareto Diagram to inform Plan-Do-Study-Act (PDSA) cycles, which included: (1) nurse-initiated analgesia at triage; (2) a new triage documentation aid for medication administration; (3) a quick reference medical directive badge for nurses; and (4) weekly targeted feedback of the project's progress at clinical team huddle. TTA decreased from 129 min (n=153) to 100 min (22.5%; n=87, p<0.05). Special cause variation was identified on the ED LOS SPC chart with nine values below the midline after the first PDSA. The number of patients that received any analgesia increased from 42% (n=372) to 47% (n=192; p=0.13) and those that received them via medical directives increased from 22% (n=154) to 44% (n=87; p<0.001). We achieved a significant reduction of TTA and an increased use of medical directives through front-line focused improvements.
Collapse
Affiliation(s)
- Victoria Woolner
- Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada
| | - Reena Ahluwalia
- Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada
| | - Hilary Lum
- Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada
| | - Kevin Beane
- Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada
| | - Jackie Avelino
- Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada
| | - Lucas B Chartier
- Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
15
|
Falchi AG, Spadoni A, Blatti C, Manzoni F, Perlini S. Pain management in the emergency department: results from an observational longitudinal prospective study in a second-level urban hospital. EMERGENCY CARE JOURNAL 2020. [DOI: 10.4081/ecj.2020.8871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Although a correct assessment of pain and an adequate analgesia represent a priority in the setting of emergency care, many studies documented an inadequate pain control. The purpose of our study is to characterize the present status of a second level Emergency Department in Italy in terms of pain assessment and treatment. Our survey investigates the multidimensional aspects of pain, the accomplishment of appropriate pain evaluation by the medical and nursing staff and the effectiveness of the treatment, in terms of pain reduction and also of customer satisfaction.
Collapse
|
16
|
Observation of Emergency Room Nurses Managing Pediatric Pain: Care to Be Given… Care Given…. Pain Manag Nurs 2020; 21:488-494. [PMID: 32631762 DOI: 10.1016/j.pmn.2020.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 03/02/2020] [Accepted: 03/11/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Although pain undeniably has negative consequences, pain management often remains suboptimal, particularly in the pediatric population in the emergency room (ER). AIM In this observational study using qualitative and quantitative methods, we investigated everyday adherence to current nursing best-practice pediatric guidelines in the ER paying particular attention to the interaction between children, parents, and nurses. METHODS An adapted version of the nursing observation tool for pain management was used to describe pediatric pain management provided by nurses caring for children (0-14 years old) admitted to the ER. We also assessed child-parent-nurse interactions. (The aim of the study was presented to the nurses as part of the survey on interactions without specifying the focus on pain management.) RESULTS: Forty-seven children were included (91 painful episodes) during the observation period (112 hours). There was a screening for pain in 55% of cases, and pain scales were used in 10% of cases. Analgesic treatments were administered in 75% of cases (procedural or disease-related pain). Follow-up evaluations were performed in 19% of cases. Nonpharmacologic approaches were scarcely used. The use of both helpful and nonhelpful languages were noted during interactions with children and parents. Parents' collaboration was rarely requested to help relieve their child's pain. CONCLUSIONS Our results show that pediatric pain management in the ER could be optimized. Parents are still not considerably involved in their child's pain management. Parents' involvement could contribute to improving pediatric pain management.
Collapse
|
17
|
Ganzijeva K, Kindereviciute I, Dagys A, Jankauskaite L. Evolution in acute pain assessment and treatment in the paediatric emergency department of a tertiary health care centre. Eur J Pain 2020; 24:773-782. [PMID: 31889356 DOI: 10.1002/ejp.1527] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 11/10/2019] [Accepted: 12/24/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Paediatric pain remains one of the most misunderstood, under-diagnosed and under-treated medical problems in children. AIM To investigate the accuracy of acute pain assessment and management in the Paediatric Emergency Department in Lithuanian University of Health Sciences Hospital. METHODS We performed a retrospective record analysis before (the year 2017) and after (the year 2018) paediatric pain training course was conducted. In total, 1,000 randomly selected outpatient records were analysed. We divided all patients into two groups: group A records from 2017 and group B from 2018. Patients were further divided into trauma and non-trauma and subdivided into four different age groups. We collected patient age, the origin of pain, pain characteristics, pain score and medication. RESULTS We compared 500 children in each group. Groups A and B consisted of 154 (30.8%) and 116 (23.2%) trauma patients, respectively. The pain was scored less in group A (420 children; 84%) compared to group B (94.4% of all 500 patients, p < .001). In all age groups, the pain was assessed more often, and pain medication was prescribed more often in group B compared to group A (p < .001). There was a tendency to assess pain more often in group A non-trauma patients (p = .054). However, pain relief in trauma patients was less adequate compared to non-trauma. CONCLUSION Our research showed improvement in pain evaluation and treatment after systemic and local changes in paediatric emergency department (PED). In group B, pain was evaluated more frequently, and patients received pain medication more often than in group A. Teenagers are still less likely to receive analgesics than toddlers. Tendency remains to give fewer painkillers to trauma patients compared to non-trauma children. SIGNIFICANCE This is one of the few studies in the Baltic region analysing changes in children's pain assessment and management in the PED after systemic and local adjustments. Our data show an impact of systemic changes and a specialized education focused on improving knowledge in acute pain diagnostics and management of medical professionals leading to better patient care.
Collapse
Affiliation(s)
- Kristina Ganzijeva
- Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.,Department of Pediatrics, Lithuanian University of Health Sciences Kauno klinikos, Kaunas, Lithuania
| | - Ieva Kindereviciute
- Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Algirdas Dagys
- Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.,Department of Pediatrics, Lithuanian University of Health Sciences Kauno klinikos, Kaunas, Lithuania
| | - Lina Jankauskaite
- Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.,Department of Pediatrics, Lithuanian University of Health Sciences Kauno klinikos, Kaunas, Lithuania
| |
Collapse
|
18
|
Gao LL, Yu JQ, Liu Q, Gao HX, Dai YL, Zhang JJ, Wang YL, Zhang TT, Yang JJ, Li YX. Analgesic Effect of Nitrous Oxide/Oxygen Mixture for Traumatic Pain in the Emergency Department: A Randomized, Double-Blind Study. J Emerg Med 2019; 57:444-452. [PMID: 31514988 DOI: 10.1016/j.jemermed.2019.06.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/11/2019] [Accepted: 06/15/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Acute pain is the most common complaint in Emergency Department (ED) admissions, and options for analgesia are limited. Nitrous oxide/oxygen possesses many properties showing it may be an ideal analgesic in the ED. OBJECTIVES The aim of this study is to evaluate the safety and analgesic effect of the fixed nitrous oxide/oxygen mixture for trauma patients in the ED. METHODS We enrolled 60 patients in this double-blind, randomized study. The treatment group received conventional pain treatment plus a mixture of 65% nitrous oxide/oxygen. The control group received the conventional pain treatment plus oxygen. Primary outcome was the reduction in pain intensity at 5 and 15 min after the start of intervention. Secondary outcomes include adverse events, physiological parameters, and satisfaction from both patients and health care professionals. RESULTS Initial pain scores for the nitrous oxide/oxygen group (6.0 [5.0-8.0]) and the oxygen group (6.75 [5.0-9.0]) were comparable (p = 0.57). The mean numerical rating scale scores at 5 min were 3.4 ± 1.8 and 7.0 ± 1.8 for nitrous oxide/oxygen and oxygen, respectively (p < 0.01). The mean pain intensity at 15 min in the treatment group was 3.0 ± 1.9, compared with 6.3 ± 2.2 in the control group (p < 0.01). Both patients' (8.0 [7.0-9.0] vs. 4.0 [2.0-6.0], p < 0.01) and physicians' (8.5 [8.0-9.0] vs. 4.0 [3.0-6.0], p < 0.01) satisfaction scores in the treatment group were significantly higher than the oxygen group. No serious adverse events were observed. CONCLUSIONS This study gives supporting evidence for the safety and effectiveness of using self-administered nitrous oxide/oxygen mixture in the ED for moderate-to-severe traumatic pain.
Collapse
Affiliation(s)
- Lu-Lu Gao
- School of Nursing, Ningxia Medical University, Yinchuan, China
| | - Jian-Qiang Yu
- Department of Pharmacology, College of Pharmacy, Ningxia Medical University, Yinchuan, China
| | - Qiang Liu
- School of Basic Medical Sciences, Ningxia Medical University, Yinchuan, China
| | - Hai-Xiang Gao
- School of Nursing, Ningxia Medical University, Yinchuan, China
| | - Ya-Liang Dai
- School of Nursing, Ningxia Medical University, Yinchuan, China
| | - Jun-Jun Zhang
- School of Nursing, Ningxia Medical University, Yinchuan, China
| | - Yi-Ling Wang
- School of Nursing, Ningxia Medical University, Yinchuan, China
| | - Ting-Ting Zhang
- School of Nursing, Ningxia Medical University, Yinchuan, China
| | - Jian-Jun Yang
- School of Public Health and Preventive Medicine, Ningxia Medical University, Yinchuan, China
| | - Yu-Xiang Li
- School of Nursing, Ningxia Medical University, Yinchuan, China
| |
Collapse
|
19
|
Williams S, Keogh S, Douglas C. Improving paediatric pain management in the emergency department: An integrative literature review. Int J Nurs Stud 2019; 94:9-20. [PMID: 30928719 DOI: 10.1016/j.ijnurstu.2019.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 02/26/2019] [Accepted: 02/26/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Children presenting to the emergency department continue to experience suboptimal pain management. While evidence-based pain management interventions are available to clinicians, effective and sustainable practice change is yet to be achieved. This practice gap requires a collaborative approach to knowledge translation targeting systems of care. OBJECTIVES The purpose of this review was to explore systems level change in the emergency department for improved paediatric pain management. DESIGN Integrative review. DATA SOURCES CINAHL, Embase, PubMed/Medline, Dynamed, Cochrane, Scopus, Prospero and Joanna Briggs Institute were systematically searched, and clinical guidelines and reference lists scanned. REVIEW METHODS Studies were screened and selected according to the inclusion criteria, and independently appraised for risk of bias. Integrative review methodology informed data extraction and synthesis, focused on organisational context and engagement, facilitation and implementation of practice change, key components of the pain management interventions, and evaluation. RESULTS Twenty studies met the inclusion criteria: 18 uncontrolled pretest-posttest and two pseudo-randomised design. Study populations ranged from children with a specific presentation, to all presenting children. All studies adopted a multifaceted approach to organisational change, bundling various interventions including pain assessment tools and management protocols, clinician education, nurse-initiated analgesia, feedback and family engagement. Four studies used local systems analysis to inform interventions and two studies applied an implementation framework. Time to analgesia was the most commonly improved primary outcome. Parent and child sensitive outcomes were assessed in five studies. Interventions that hold the most promise for optimised pain management if embedded in the workplace include nurse-initiated analgesia and family involvement at each stage of pain management in the emergency department. CONCLUSION The way forward is to respectfully engage all stakeholders-children, parents and clinicians-to collaboratively develop evidence-based, sustainable solutions aligned with the emergency department context. Guided by an implementation framework, future research designed to creatively translate evidence into practice and facilitate change at a systems level is a priority. Key to this solution is the integration of family involvement in pain management, considering child and family sensitive outcome measures. Effectiveness of new interventions should be evaluated in the short and long term to embed sustainable practice change. Frontline nurses are well placed to lead this transformation in paediatric pain management in the emergency department.
Collapse
Affiliation(s)
- Suzanne Williams
- Queensland University of Technology (QUT), School of Nursing, Kelvin Grove, QLD, Australia; Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Kelvin Grove, QLD, Australia; Children's Health Queensland Hospital and Health Service, Queensland Health, QLD, Australia.
| | - Samantha Keogh
- Queensland University of Technology (QUT), School of Nursing, Kelvin Grove, QLD, Australia; Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Kelvin Grove, QLD, Australia; Alliance for Vascular Access Teaching and Research Group (AVATAR), Menzies Health Institute Queensland, Griffith University, QLD, Australia
| | - Clint Douglas
- Queensland University of Technology (QUT), School of Nursing, Kelvin Grove, QLD, Australia; Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Kelvin Grove, QLD, Australia; Conjoint Associate Professor, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| |
Collapse
|
20
|
Abstract
BACKGROUND Investigations on the quality of nursing care relating to various care problems are rare. PURPOSE This study assessed the (1) fulfillment of structural indicators, (2) application of nursing interventions as process indicators, and (3) prevalence rate as outcome indicators with regard to various care problems. METHODS A cross-sectional multicenter study was conducted in 30 Austrian hospitals with 2878 patients. RESULTS The highest number of structural quality indicators was fulfilled for pressure ulcers, falls, restraints, and pain. In malnutrition and urinary incontinence, a lack of structural indicators was observed. Most interventions were offered to patients with pressure ulcers or those who had experienced a fall. The lowest frequency of nursing interventions was seen in malnourished and incontinent persons. CONCLUSION There is a need for the national adaptation of guidelines for malnutrition and urinary incontinence. This may increase the frequency of evidence-based nursing interventions.
Collapse
|
21
|
Ali S, Sivakumar M, Beran T, Scott SD, Vandermeer B, Curtis S, Jou H, Hartling L. Study protocol for a randomised controlled trial of humanoid robot-based distraction for venipuncture pain in children. BMJ Open 2018; 8:e023366. [PMID: 30552264 PMCID: PMC6303653 DOI: 10.1136/bmjopen-2018-023366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 10/15/2018] [Accepted: 10/26/2018] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Intravenous insertion (IVI) is a very common procedure in the emergency department (ED). IVI is often painful and stressful for both children and their families. Currently, distraction therapy is not used as a standard of care for IVI in North America. We propose that interaction with a humanoid robot may effectively distract children during IVI thereby reducing their pain and distress. METHODS AND ANALYSIS This randomised controlled superiority trial will be conducted in a Canadian paediatric ED. We plan to recruit 80 patients. Children will be eligible if they (1) are 6 to 11 years of age, (2) need an IVI, (3) are fully conscious and alert, (4) have sufficient knowledge of the English language to understand and complete the study assessments and (5) are accompanied by a legal guardian. Our primary objective is to compare patient-reported pain and distress with the use of distraction (via a humanoid robot) versus standard care in children. The primary outcomes will be (1) self-reported pain, as measured by the Faces Pain Scale-Revised and (2) observed distress, as measured by the Observational Scale of Behavioural Distress-Revised. Secondary outcomes will include (1) measuring parental anxiety, (2) examining the association between parental anxiety and child outcomes and (3) children's degree of engagement with the humanoid robot via the Intrinsic Motivation Inventory tool. First enrolment occurred in April 2017 and is ongoing. ETHICS AND DISSEMINATION This study has been approved by the Health Research Ethics Board (University of Alberta). Informed consent to participate will be obtained from all participants' parents/guardian, in conjunction with assent from the participant themselves. This study data will be submitted for publication regardless of results. Purchase of the robot was facilitated through a Stollery Children's Hospital Foundation donation. Recruitment costs are supported by the Women and Children's Health Research Institute. TRIAL REGISTRATION NUMBER NCT02997631; Pre-results.
Collapse
Affiliation(s)
- Samina Ali
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Women & Children’s Health Research Institute, Edmonton, Alberta, Canada
| | - Mithra Sivakumar
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Tanya Beran
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shannon D Scott
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Ben Vandermeer
- Department of Pediatrics, Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada
| | - Sarah Curtis
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Women & Children’s Health Research Institute, Edmonton, Alberta, Canada
| | - Hsing Jou
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Lisa Hartling
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Department of Pediatrics, Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
22
|
Abstract
Pediatric emergency medicine quality work continues to focus on the National Academies of Sciences, Engineering, and Medicine's 6 domains of quality, with a need for specific emphasis on equity and patient centeredness. Adopting the principles of high-reliability organizations, pediatric emergency departments should become increasing transparent with benchmarking and collaboration across institutions in order to develop an infrastructure for quality and safety to improve the care of pediatric patients in the emergency department.
Collapse
Affiliation(s)
- Brandon C Ku
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19146, USA.
| | - James M Chamberlain
- Department of Pediatrics, Division of Emergency Medicine, Children's National Medical Center, George Washington University School of Medicine, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Kathy N Shaw
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19146, USA
| |
Collapse
|
23
|
Shave K, Ali S, Scott SD, Hartling L. Procedural pain in children: a qualitative study of caregiver experiences and information needs. BMC Pediatr 2018; 18:324. [PMID: 30316301 PMCID: PMC6186099 DOI: 10.1186/s12887-018-1300-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/01/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Children experience multiple painful procedures when being cared for in emergency departments (EDs). Unfortunately, evidence-based interventions to manage such pain and distress are under-utilized across EDs. Caregivers are uniquely positioned and invested to advocate for the adaptation of such evidence into practice. Our objective was to gather information from caregivers of children experiencing procedural pain in the ED to inform the development of a novel, caregiver-focused knowledge translation (KT) tool. METHODS The study design was qualitative description. Caregivers of children who underwent intravenous (IV) insertion or venipuncture in the pediatric ED at an urban tertiary care centre were interviewed. Thematic analysis was applied to the data. The TRanslating Emergency Knowledge for Kids (TREKK) Parent Advisory Group continuously informed this study, and provided input on interview guide development and piloting, data collection, analysis of the data, interpretation of the results, and development of next steps. RESULTS Interviews revealed four major themes: 1) source of healthcare information; 2) delivering healthcare information; 3) communication with caregivers; and 4) procedure-related anxiety and long-term effects. Caregivers most valued receiving information directly from their healthcare provider. They also expressed that healthcare providers should direct information about the procedure to their child and identified strategies to involve children in their care. Caregivers wanted to be empowered to ask informed questions of their healthcare providers. Finally, caregivers reported negative experiences with procedures for their children, occurring mainly at non-pediatric centres. CONCLUSIONS We have identified core information needs for caregivers whose children are experiencing IV insertion or venipuncture. These results will form the foundation for the development of a KT tool that may empower caregivers to actively participate in their child's healthcare.
Collapse
Affiliation(s)
- Kassi Shave
- Alberta Research Centre for Health Evidence (ARCHE), University of Alberta, ECHA 4-472, 11405-87 Avenue, Edmonton, AB T6G 1C9 Canada
- Department of Pediatrics, University of Alberta, ECHA 4-472, 11405-87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Samina Ali
- Department of Pediatrics, University of Alberta, ECHA 4-472, 11405-87 Avenue, Edmonton, AB T6G 1C9 Canada
- Women and Children’s Health Research Institute, ECHA 4-472, 11405-87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Shannon D. Scott
- Women and Children’s Health Research Institute, ECHA 4-472, 11405-87 Avenue, Edmonton, AB T6G 1C9 Canada
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence (ARCHE), University of Alberta, ECHA 4-472, 11405-87 Avenue, Edmonton, AB T6G 1C9 Canada
- Department of Pediatrics, University of Alberta, ECHA 4-472, 11405-87 Avenue, Edmonton, AB T6G 1C9 Canada
| |
Collapse
|
24
|
Affiliation(s)
- Mohsen Saidinejad
- Department of Emergency Medicine, Harbor UCLA Medical Center, David Geffen School of Medicine at UCLA, 1000 West Carson Street, Torrance, CA 90502, USA.
| |
Collapse
|
25
|
Caspi S, Meidan R, Peless E, Raizman E. Nurse-initiated oral opioid pain protocol improves the quality of musculoskeletal pain management in the emergency department. Int Emerg Nurs 2018; 43:29-33. [PMID: 30031736 DOI: 10.1016/j.ienj.2018.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 07/02/2018] [Accepted: 07/06/2018] [Indexed: 11/19/2022]
Affiliation(s)
| | | | - Elad Peless
- Emergency Medicine Department, Hadassah Mount Scopus, Israel
| | - Ela Raizman
- Nursing Division, Hadassah Mt. Scopus University Hospital, 4 Churchill Blvd., Jerusalem 91240, Israel.
| |
Collapse
|
26
|
Brienza A, Gianforcaro A, Suffoletto B, Callaway CW, Pacella ML. The utility of assessing for pain interference and psychological factors among emergency department patients who present with pain. Gen Hosp Psychiatry 2018. [PMID: 29518742 DOI: 10.1016/j.genhosppsych.2018.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ashley Brienza
- Department of Emergency Medicine, University of Pittsburgh, Iroquois Building, Suite 400A, 3600 Forbes Ave, Pittsburgh, PA 15261, United States.
| | - Alexandro Gianforcaro
- Department of Emergency Medicine, University of Pittsburgh, Iroquois Building, Suite 400A, 3600 Forbes Ave, Pittsburgh, PA 15261, United States.
| | - Brian Suffoletto
- Department of Emergency Medicine, University of Pittsburgh, Iroquois Building, Suite 400A, 3600 Forbes Ave, Pittsburgh, PA 15261, United States.
| | - Clifton W Callaway
- Department of Emergency Medicine, University of Pittsburgh, Iroquois Building, Suite 400A, 3600 Forbes Ave, Pittsburgh, PA 15261, United States.
| | - Maria L Pacella
- Department of Emergency Medicine, University of Pittsburgh, Iroquois Building, Suite 400A, 3600 Forbes Ave, Pittsburgh, PA 15261, United States.
| |
Collapse
|
27
|
Parker R, McKeever S, Wiseman T, Twycross A. An Integrative Review of Interventions to Support Parents When Managing Their Child's Pain at Home. Pain Manag Nurs 2018; 19:139-156. [DOI: 10.1016/j.pmn.2017.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 10/03/2017] [Accepted: 10/06/2017] [Indexed: 01/24/2023]
|
28
|
Cohen MM, Ben-Meir M, Andrianopoulos N. Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non-inferiority trial. Med J Aust 2018; 208:189. [PMID: 29553695 DOI: 10.5694/mja17.00735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 08/04/2017] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Nick Andrianopoulos
- Centre for Cardiovascular Research and Education and Therapeutics, Monash University, Melbourne, VIC
| |
Collapse
|
29
|
Giusti GD, Reitano B, Gili A. Pain assessment in the Emergency Department. Correlation between pain rated by the patient and by the nurse. An observational study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:64-70. [PMID: 29644991 PMCID: PMC6357625 DOI: 10.23750/abm.v89i4-s.7055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 02/27/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY Pain is always present in the Emergency Department (ED), but is often underestimated. The primary purpose of this study is to analyze the degree to which the intensity of pain is underestimated or overestimated in the perception of the nurse and the patient in the ED. The secondary objective of this research is to study possible factors that lead to these discrepancies in assessment. METHODS The observational study was carried out in two Hospitals in Central Italy. The sample population was based on 130 patients and 26 nurses. A questionnaire was given to the patients who provided personal data followed by information regarding their pain, including an assessment of the intensity of pain on a scale from 0 to 10. A similar questionnaire was given to the nurses. RESULTS The average score based on the numeric rating scale (NRS) to assess the intensity of pain perceived by the patients is 6.16, while the numerical average estimated by the nurses based on their assessment is 5. Using the t test we found that the average between nurse and patient assessments was very significant. The analysis of the nurses' characteristics and professional experiences, age, years of employment and years of service in the ED are all significant variables affecting the discrepancy between the nurses' and patients' assessments of pain. As previous studies have shown, nurses tend to underestimate the degree of pain. In fact, in only 55.5% of the cases was there a correspondence in the evaluations of the intensity of pain done by nurses and patients, and in no case did the nurses' evaluation exceed that of the patients. CONCLUSIONS This study reveals the persistent difficulty in pain management, while attempting contemporaneously to communicate the importance of the assessment, since adequate understanding of pain renders it possible to recognize and treat it.
Collapse
|
30
|
Educational Intervention Effect on Pain Management Quality in Emergency Department; a Clinical Audit. ADVANCED JOURNAL OF EMERGENCY MEDICINE 2018; 2:e16. [PMID: 31172079 PMCID: PMC6549047 DOI: 10.22114/ajem.v0i0.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction Pain is a frequent complaint of patients who are referred to the emergency department (ED), which is ignored or mismanaged and, almost always, approached in terms of determining the cause of pain instead of pain management. Pain management is a challenging issue in the ED. Objective This study was conducted to determine the effect of emergency resident's education about pain assessment and pain-relief drugs in the improvement in pain management. Method A clinical audit was carried out during the year 2015 in the ED of Imam Hossein Hospital, Tehran, Iran. All patients over 16-year-old who had been complaining of pain or another complaint that included pain were eligible. Data were collected using a preformed checklist. One senior emergency medicine resident was responsible for filling the checklist. In the first phase, patients were enrolled into the study and were divided into two groups according to whether they had or did not have a pain management order. In the second phase, the first- and second-year emergency medicine residents were trained during the various classes that they were required to attend, through a workshop conducted by experienced professors, and based on existing valid guidelines. In the third phase, patients were enrolled into the study, and the same checklists were completed. Results A total of 803 patients (401 before training and 402 after) were assessed. The mean age of the patients before and after training of the residents was 59.19 ± 44.45 and 40.24 ± 19.40 years, respectively. The demographic characteristics of patients were not significantly different before and after the training period (p > 0.05). The most common cause of pain was soft tissue injury, both before (36.3%) and after training (34.3%). The most frequent drug that was administered for pain control was morphine, both before (62.5%) and after (41.4%) training. Although the number of patients with moderate pain intensity was higher during the after-training period, pain control quality was described to be better in this group and success rate of pain control was significantly increased after training (p < 0.001). Conclusion Findings from the present study showed that there was a significant deficiency in pain management of the admitted patients, and the most common reason for this was the physician's fear of the drug's side effects. However, significant progress was seen after the training regarding pain management process in ED.
Collapse
|
31
|
Mura P, Serra E, Marinangeli F, Patti S, Musu M, Piras I, Massidda MV, Pia G, Evangelista M, Finco G. Prospective study on prevalence, intensity, type, and therapy of acute pain in a second-level urban emergency department. J Pain Res 2017; 10:2781-2788. [PMID: 29263692 PMCID: PMC5732548 DOI: 10.2147/jpr.s137992] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim Pain represents the most frequent cause for patient admission to emergency departments (EDs). Oligoanalgesia is a common problem in this field. The aims of this study were to assess prevalence and intensity of pain in patients who visited a second-level urban ED and to evaluate the efficacy of pharmacological treatment administered subsequent to variations in pain intensity. Methods A 4-week prospective observational study was carried out on 2,838 patients who visited a second-level urban ED. Pain intensity was evaluated using the Numeric Rating Scale at the moment of triage. The efficacy of prescribed analgesic therapy was evaluated at 30 and 60 minutes, and at discharge. Data concerning pain intensity were classified as absent, slight, mild, or severe. Pain was evaluated in relation to the prescribed therapy. Results Pain prevalence was 70.7%. Traumatic events were the primary cause in most cases (40.44%), followed by pain linked to urologic problems (13.52%), abdominal pain (13.39%), and nontraumatic musculoskeletal pain (7.10%). Only 32.46% of patients were given pharmacological therapy. Of these, 76% reported severe pain, 19% moderate, and 5% slight, and 66% received nonsteroidal anti-inflammatory drugs or paracetamol, 4% opioids, and 30% other therapies. A difference of at least 2 points on the Numerical Rating Scale was observed in 84% of patients on reevaluation following initial analgesic therapy. Conclusion Pain represents one of the primary reasons for visits to EDs. Although a notable reduction in pain intensity has been highlighted in patients who received painkillers, results show that inadequate treatment of pain in ED continues to be a problem.
Collapse
Affiliation(s)
- Paolo Mura
- Department of Medical Sciences "M. Aresu", University of Cagliari, Cagliari, Italy
| | - Elisabetta Serra
- Department of Medical Sciences "M. Aresu", University of Cagliari, Cagliari, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Medicine, University of L'Aquila, L'Aquila, Italy
| | - Sebastiano Patti
- Department of Emergency Medicine, Santissima Trinità Hospital, Cagliari, Italy
| | - Mario Musu
- Department of Medical Sciences "M. Aresu", University of Cagliari, Cagliari, Italy
| | - Ilenia Piras
- Department of Emergency Medicine, Santissima Trinità Hospital, Cagliari, Italy
| | | | - Giorgio Pia
- Department of Emergency Medicine, Santissima Trinità Hospital, Cagliari, Italy
| | - Maurizio Evangelista
- Department of Anesthesiology and Pain Medicine, Cattolica University, Rome, Italy
| | - Gabriele Finco
- Department of Medical Sciences "M. Aresu", University of Cagliari, Cagliari, Italy
| |
Collapse
|
32
|
Woodward S, Berry K, Bucci S. A systematic review of factors associated with service user satisfaction with psychiatric inpatient services. J Psychiatr Res 2017; 92:81-93. [PMID: 28412601 DOI: 10.1016/j.jpsychires.2017.03.020] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/29/2017] [Accepted: 03/30/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Satisfaction is seen as an indicator of the quality of mental health services and has been related to outcomes and compliance with treatment. The current review seeks to examine the factors relating to satisfaction with inpatient services. METHOD A search was conducted of PsycInfo, Web of Science, Cinahl, Embase and Medline databases. Screening resulted in 32 papers being included in the review. Papers were subject to quality assessment using the Mixed Methods Appraisal Tool (MMAT). RESULTS Review of the included papers suggested factors relating to satisfaction could be broadly classified as either service user or service/ward related. Service user related factors included findings that satisfaction was higher when service users were admitted voluntarily. Service related factors included findings that satisfaction was negatively associated with experiences of coercion and positively associated with being on an open ward. CONCLUSION It appears that coercion has a key role in ratings of satisfaction. Additionally, service users reported an impact of staff relationships, and the ward environment. Satisfaction is associated with a range of factors, an awareness of which will allow for the development of quality services that meet the needs of service users.
Collapse
Affiliation(s)
- Sarah Woodward
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, United Kingdom
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, United Kingdom
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, United Kingdom.
| |
Collapse
|
33
|
Andrés JD, Pogatzki-Zahn E, Huygen F, Neugebauer E, Fawcett W. Controlling acute pain to improve the quality of postoperative pain management: an update from the European Society of Regional Anesthesia meeting held in Maastricht (September 2016). Pain Manag 2017; 7:513-522. [PMID: 28793825 DOI: 10.2217/pmt-2017-0026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Improvement in postoperative pain management remains a global concern with a significant unmet need for patients. This was the focus of a 'Change Pain' session at the 35th European Society of Regional Anesthesia meeting (Maastricht, September 2016). Awareness of the size and nature of the problem is important to improve postoperative pain management strategies. Optimal treatment of acute pain should aim to avoid long-term sequelae such as the development of chronic pain disorders (e.g., phantom limb pain). Cases highlighting unsuccessful and successful strategies to manage individuals undergoing surgery were presented. The benefits of personalized care, encouraging patients to be more involved in decisions regarding their treatment and their preferred clinical outcomes were discussed and considered to be a step forward in acute pain management.
Collapse
Affiliation(s)
- Jose De Andrés
- Departments of Anesthesia & Surgery, Critical Care & Multidisciplinary Pain Management, Valencia University General Hospital, Anesthesia Division, Valencia School of Medicine, Valencia, Spain
| | - Esther Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care & Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Frank Huygen
- Erasmus MC, University Hospital, Rotterdam, The Netherlands
| | - Edmund Neugebauer
- Brandenburg Medical School Theodor Fontane & Health Services Research, Witten/Herdecke University, Campus Neuruppin, Neuruppin, Germany
| | - William Fawcett
- Department of Anesthesia, Royal Surrey County Hospital, Egerton Road, Royal Surrey, Guildford, UK.,Faculty of Health & Medical Sciences, Duke of Kent Building, University of Surrey, Guildford, UK
| |
Collapse
|
34
|
|
35
|
Hughes JA, Cabilan CJ, Staib A. Effect of the 4-h target on time-to-analgesia in an Australian emergency department: a pilot retrospective observational study. AUST HEALTH REV 2017; 41:185-191. [DOI: 10.1071/ah16025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 04/14/2016] [Indexed: 11/23/2022]
Abstract
Objectives
The aim of the present study was to assess the relationship between and the effect of the 4-h target or National Emergency Access Target (NEAT) on the time-to-analgesia (TTA), as well as the provision of analgesia in an adult emergency department (ED).
Methods
The present study was a pilot descriptive explorative retrospective cohort study conducted in a public metropolitan ED. Eligible presentations for analysis were adults presenting with a documented pain score of ≥4 out of 10 between 1 and 14 September 2014. Triage Category 1, pregnant, chest pain and major trauma cases were excluded from the study. As a result, data for 260 patients were analysed.
Results
Of 260 patients, 176 had analgesia with a median TTA of 49 min. Increased NEAT compliance did not significantly decrease TTA. However, when the factors that affected the provision of analgesia were analysed, an association was demonstrated between Admitted and Short Stay NEAT performance and the provision of analgesia. The likelihood of receiving analgesia at all increased as Admitted and Short Stay NEAT compliance improved.
Conclusion
NEAT is a significant health policy initiative with little clinical evidence supporting its implementation. However, as the Admitted NEAT compliance increases, the probability of receiving analgesia increases, demonstrating a possible link between hospital function and clinical care provision that needs to be explored further.
What is known about the topic?
The 4-h target or NEAT is a widely used initiative in EDs to allay crowding and access block. However, little is known of its impact on clinical endpoints, such as TTA.
What does this paper add?
TTA was not significantly reduced as NEAT compliance increased. However, when the focus was on the probability of receiving analgesia, the results demonstrated that an improvement in Admitted and Short Stay NEAT compliance was associated with an increase in the likelihood of patients receiving analgesia.
What are the implications for practitioners?
NEAT is a relatively recent initiative, hence evidence of its effect on clinically orientated outcomes is limited. Nevertheless, evidence of safety and effectiveness is emerging. The results of the present pilot study provide preliminary data on the timeliness of patient-centred care as demonstrated by TTA and administration of analgesia when required. Further, the results would seem to suggest that the provision of analgesia is affected by how timely patients are moved out of the ED to the in-patient setting. As for future investigations on TTA as a result of NEAT, a wider time period should be considered so that the accurate effect of compliance thresholds (e.g. ≥90%, 81–89%, ≤80%) of NEAT can be explored.
Collapse
|
36
|
Pain management of trauma patients in the emergency department: a study in a public hospital in Iran. Int Emerg Nurs 2016; 33:53-58. [PMID: 27956149 DOI: 10.1016/j.ienj.2016.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 10/05/2016] [Accepted: 10/30/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Pain is a common problem which the patients in emergency departments (ED) face, especially trauma patients under treatment may suffer from physical, psychological and ethical issues. The purpose of this study was to evaluate traumatic pain management in the emergency department at a public hospital in Iran in 2014. METHODS This observational prospective study was conducted on 450 trauma patients admitted to a trauma emergency department. The tool used in this study has three parts: demographic data, data of trauma, and VRS (Verbal Rating Scales) score at a 7-point scale-at the arrival time to 4h later. The statistical analysis was conducted by using Mann-Whitney and Kruskal-Wallis tests, repeated measures, survival analysis, and multiple regression analysis. RESULTS The majority of the samples were male (83.3%) with the mean age of 35.2years. The patients mostly suffered from contusions and strains (42.4%). The majority of the patients [274 patients (60.8%)] received no intervention for pain relief and only 60 patients (13.3%) received analgesics. The mean time period of the first analgesic utilization was 41 (±20.4) minutes. Pain in admission, pain assessment, and receiving intervention could explain the 32% of pain reduction. No other variables such as age, sex, education, kind of trauma, and the shift of admission were involved in pain reduction. CONCLUSIONS This research study demonstrated that comprehensive, adequate pain management remains an obscure goal within the emergency nursing setting. There is a need to undertake further research and develop educational programs on effective analgesic practice in pain management.
Collapse
|
37
|
Twycross A, Forgeron P, Chorne J, Backman C, Finley GA. Pain as the neglected patient safety concern: Five years on. J Child Health Care 2016; 20:537-541. [PMID: 27091955 DOI: 10.1177/1367493516643422] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Five years ago, we published a commentary in the Canadian Medical Association Journal arguing that inadequately managed pain in children should be considered an adverse event, a harmful patient outcome. We argued that inadequately managed pain meets the definition of an adverse event and further hypothesized that treating pain as an adverse event may improve care by raising health care administrators and quality improvement experts' awareness of this issue. In this article, we reflect on the progress made in both moving this proposition forward and testing out the concept. We then move on to look at what still needs to be done to ensure that children's pain is managed effectively.
Collapse
Affiliation(s)
- Alison Twycross
- 1 Department for Children's Nursing, London South Bank University, London, UK
| | - Paula Forgeron
- 2 School of Nursing, Faculty of Health Sciences, University of Ottawa, Ontario, Canada
| | - Jill Chorne
- 3 Departments of Anesthesia, Pain Management and Perioperative Medicine and Psychology and Neuroscience, Dalhousie University, Halifax, Canada.,4 Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada
| | - Chantal Backman
- 2 School of Nursing, Faculty of Health Sciences, University of Ottawa, Ontario, Canada.,5 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - G Allen Finley
- 3 Departments of Anesthesia, Pain Management and Perioperative Medicine and Psychology and Neuroscience, Dalhousie University, Halifax, Canada.,4 Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada
| |
Collapse
|
38
|
Reynolds SL, Studnek JR, Bryant K, VanderHave K, Grossman E, Moore CG, Young J, Hogg M, Runyon MS. Study protocol of a randomised controlled trial of intranasal ketamine compared with intranasal fentanyl for analgesia in children with suspected, isolated extremity fractures in the paediatric emergency department. BMJ Open 2016; 6:e012190. [PMID: 27609854 PMCID: PMC5020878 DOI: 10.1136/bmjopen-2016-012190] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Fentanyl is the most widely studied intranasal (IN) analgesic in children. IN subdissociative (INSD) ketamine may offer a safe and efficacious alternative to IN fentanyl and may decrease overall opioid use during the emergency department (ED) stay. This study examines the feasibility of a larger, multicentre clinical trial comparing the safety and efficacy of INSD ketamine to IN fentanyl and the potential role for INSD ketamine in reducing total opioid medication usage. METHODS AND ANALYSIS This double-blind, randomised controlled, pilot trial will compare INSD ketamine (1 mg/kg) to IN fentanyl (1.5 μg/kg) for analgesia in 80 children aged 4-17 years with acute pain from a suspected, single extremity fracture. The primary safety outcome for this pilot trial will be the frequency of cumulative side effects and adverse events at 60 min after drug administration. The primary efficacy outcome will be exploratory and will be the mean reduction of pain scale scores at 20 min. The study is not powered to examine efficacy. Secondary outcome measures will include the total dose of opioid pain medication in morphine equivalents/kg/hour (excluding study drug) required during the ED stay, number and reason for screen failures, time to consent, and the number and type of protocol deviations. Patients may receive up to 2 doses of study drug. ETHICS AND DISSEMINATION This study was approved by the US Food and Drug Administration, the local institutional review board and the study data safety monitoring board. This study data will be submitted for publication regardless of results and will be used to establish feasibility for a multicentre, non-inferiority trial. TRIAL REGISTRATION NUMBER NCT02521415.
Collapse
Affiliation(s)
- Stacy L Reynolds
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
| | | | - Kathleen Bryant
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Kelly VanderHave
- Department of Orthopedics, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Eric Grossman
- Department of Pediatric Surgery, Levine Children's Hospital, Concord, North Carolina, USA
| | - Charity G Moore
- Dickson Advanced Analytics, Carolinas Healthcare System, Charlotte, North Carolina, USA
| | - James Young
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Melanie Hogg
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Michael S Runyon
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
| |
Collapse
|
39
|
|
40
|
Van Woerden G, Van Den Brand CL, Den Hartog CF, Idenburg FJ, Grootendorst DC, Van Der Linden MC. Increased analgesia administration in emergency medicine after implementation of revised guidelines. Int J Emerg Med 2016; 9:4. [PMID: 26860533 PMCID: PMC4749514 DOI: 10.1186/s12245-016-0102-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 02/03/2016] [Indexed: 01/25/2023] Open
Abstract
Background The most common complaint of patients attending the emergency department (ED) is pain, caused by different diseases. Yet the treatment of pain at the ED is suboptimal, and oligoanalgesia remains common. The objective of this study is to determine whether the administration of analgesia at the ED increases by implementation of revised guidelines in pain management. Methods We conducted a prospective pre-post intervention cohort study with implementation of a revised guideline for pain management at our ED, in which nurses are allowed to administer analgesia (including low-dosage piritramid (opioid) intravenous) without doctor intervention. Numeric Rating Scales (NRS) were measured, and administration of medication (main outcome) was documented. We included every adult patient presenting with pain (NRS 4–10) at the ED. Results A total of 2107 patients (1089 pre-implementation phase and 1018 post-implementation phase) were included in our study. During pre-implementation, 25.4 % of the patients with NRS between 4 and 10 received analgesia. After implementation, 32.0 % of these patients received analgesia (p < 0.001). Conclusions After implementation of the revised guidelines in pain management at the ED, the administration of pain medication increased significantly. Nevertheless, the percentage of patients in pain receiving analgesia remain low (32 % after implementation).
Collapse
Affiliation(s)
- Geesje Van Woerden
- Emergency Department, Medical Centre Haaglanden, P.O. Box 432, 2501, CK, The Hague, The Netherlands.
| | - Crispijn L Van Den Brand
- Emergency Department, Medical Centre Haaglanden, P.O. Box 432, 2501, CK, The Hague, The Netherlands.
| | - Cornelis F Den Hartog
- Department of Anaesthesiology, Medical Centre Haaglanden, P.O. Box 432, 2501, CK, The Hague, The Netherlands.
| | - Floris J Idenburg
- Department of Surgery, Medical Centre Haaglanden, P.O. Box 432, 2501, CK, The Hague, The Netherlands.
| | - Diana C Grootendorst
- Landsteiner Institute, Medical Centre Haaglanden, P.O. Box 432, 2501, CK, The Hague, The Netherlands.
| | | |
Collapse
|
41
|
Borland ML, Shepherd M. Quality in paediatric emergency medicine: Measurement and reporting. J Paediatr Child Health 2016; 52:131-6. [PMID: 27062615 DOI: 10.1111/jpc.13077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 07/12/2015] [Accepted: 07/30/2015] [Indexed: 11/29/2022]
Abstract
There is a clear demand for quality in the delivery of health care around the world; paediatric emergency medicine is no exception to this movement. It has been identified that gaps exist in the quality of acute care provided to children. Regulatory bodies in Australia and New Zealand are moving to mandate the implementation of quality targets and measures. Within the paediatric emergency department (ED), there is a lack of research into paediatric specific indicators. The existing literature regarding paediatric acute care quality measures has been recently summarised, and expert consensus has now been reported. It is clear that there is much work to be performed to generalise this work to ED. We review suggestions from the current literature relating to feasible indicators within the paediatric acute care setting. We propose options to develop a quality 'scorecard' that could be used to assist Australian and New Zealand EDs with quality measurement and benchmarking for their paediatric patients.
Collapse
Affiliation(s)
- Meredith L Borland
- Emergency Department, Princess Margaret Hospital, Perth, Western Australia, Australia.,Schools of Paediatric and Child Health, Western Australia, Australia.,Primary Aboriginal and Rural Healthcare, University of Western Australia, Perth, Western Australia, Australia
| | - Mike Shepherd
- Children's Emergency Department, Starship Children's Hospital.,Auckland District Health Board.,Department of Paediatrics, University of Auckland, Auckland, New Zealand
| |
Collapse
|
42
|
Dale J, Bjørnsen LP. Assessment of pain in a Norwegian Emergency Department. Scand J Trauma Resusc Emerg Med 2015; 23:86. [PMID: 26514633 PMCID: PMC4625614 DOI: 10.1186/s13049-015-0166-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 10/21/2015] [Indexed: 12/02/2022] Open
Abstract
Background Although pain management is a fundamental aspect of care in emergency departments (EDs), inadequate treatment of pain is unfortunately common. There are multiple local protocols for pain assessment in the ED. This study evaluated whether the initial assessment and treatment of pain in the ED are in accordance with the in-hospital protocol of the ED at a Norwegian University Hospital. Materials and methods Prospective data on pain assessment and initial treatment in the ED were collected from nursing and physician documentation. The patients’ perceptions of subjective pain were recorded using a numerical rating scale (NRS) that ranged from 0 to 10. Results Seventy-seven percent of the 764 enrolled patients were evaluated for pain at arrival. Female patients had a higher probability of not being asked about pain, but there was no difference in the percentage of patients asked about pain with respect to age. Additionally, patients with low oxygen saturation and systolic blood pressure were less likely to be asked about pain. Of those with moderate and severe pain (58 %), only 14 % received pain relief. Discussion Assessment and treatment of pain in the ED are inadequate and not in line with the local protocols. A focus on strategies to improve pain treatment in the ED is a necessary aspect of developing optimal acute patient care in Norway in the future.
Collapse
Affiliation(s)
- Jostein Dale
- Emergency Department, Clinic of Emergency Medicine and Prehospital Care, St. Olav's Hospital, Trondheim, Norway
| | - Lars Petter Bjørnsen
- Emergency Department, Clinic of Emergency Medicine and Prehospital Care, St. Olav's Hospital, Trondheim, Norway.
| |
Collapse
|