Tweak to ED computer system cuts delays to analgesia
MedWire News: Australian researchers say that a simple adjustment to their emergency department (ED) computer system to mandate pain scoring at patient triage led to "substantially" faster provision of initial pain relief.
"The intervention required only a single change within our computerized information system and a single additional question to each patient at triage," say Jaideep Vazirani (Royal Melbourne Hospital) and Jonathan Knott (University of Melbourne).
The researchers also trialed an educational program to encourage rapid use of analgesia, but this, "which required effort and time commitment, afforded no additional benefit," they report in the Annals of Emergency Medicine.
The study included 35,628 ED patients, 36.3% of whom received analgesics. Of these patients, 8743 were treated before any study intervention was implemented, 8462 were seen after the change to the computer system, 9043 after the educational program, and 9380 at follow-up 12 months after baseline.
During the 8-week pre-intervention period, triage pain scores were recorded in 72.6% of patients. After the change to the computer system, this rose to 93.3% of patients, with pain scores missed only for critical patients who bypassed standard triage.
The median time to patients receiving analgesia was 123 minutes during the pre-intervention period, which fell to 95 minutes during the 8 weeks after the change to the computer system. The reduction was consistent across all categories of pain score, pain severity, and triage, and for all classes of analgesics.
The team notes that the ED staff were not informed that a study was taking place, and all data were obtained from electronic databases. This avoided changes in people's behavior in response to being observed.
Time to analgesia did not change further in the 8 weeks after delivery of the educational package, at a median of 98 minutes. Vazirani and Knott observe that previous studies have shown benefits with educational programs. "It is possible that the failure to realize additional benefit of the education package was due to content, delivery, or missed staff," they say.
By the 12-month follow-up, the median time to analgesia was 78 minutes, which was 45 minutes (36.4%) faster than at baseline. The researchers say that their study is the first to demonstrate sustained improvement so long after the intervention.
"Health care providers often underestimate pain compared with patient self-assessments," concludes the team. "A mandatory pain score may be the necessary flag to improve responsiveness, which at triage allows the earliest possible identification of patient distress."
By Eleanor McDermid