292 Improvement of pain management in emergency medicine: a multicentric audit of 50 emergency services

Abstract

Background and ObjectivesThe objective is (1) to assess pain management in emergency services (ES) and (2) to assess the impact of quality improvement measures.ProgramA quality assurance process was developed and implemented by 50 French emergency services (ES) based in teaching, public, private and military hospitals. An initial retrospective audit of medical charts (T0) allowed development of quality initiatives and prospective evaluation of their impact at three monthly intervals (T1 and T2). For each ES, 50 medical charts were randomly selected. Inclusion criteria were: all patients aged ≥15 years old presenting to the ES. There were no exclusion criteria. Data collected included general demographic data, diagnosis, presence of pain as the primary motif for consultation, assessment of the pain intensity (PI) at admission and after the care management, analgesic treatments and times of pain care management. Outcome measures were: time to PI assessment at admission, time to treatment, proportion of patients assessed, proportion of patients with adequate pain relief. Statistical analysis was performed using ANOVA for quantitative data and chi-square test for qualitative data.Results7516 patients were included during the 3 periods (T0 n=2679, T1 n=2498, T2 n=2339). 4670 patients complained of pain at admission (62% of the studied population). The rate of patients presenting with severe pain and treated by morphine was: T0 n=22 (11%), T1 n=46 (11%), T2 n=36 (8%). Abstract 292 Table 1n=4670T0 (n=1580)T1 (n=1598)T2 (n=1492)pPatients with PI assessment (%)465 (29%)992 (62%)1073 (72%)0.0001Treated patients (%)728 (46%)782 (49%)801 (54%)0.001Assessed patients last period (%)144 (9%)329 (21%)407 (27%)0.0001Patients with pain relief (%)119 (8%)249 (16%)333 (22%)0.0001Time to assessment (min±SD)65±15966±14861±148NSTime to treatment (min±SD)90±13792±15185±1350.05 Discussion and ConclusionThis wide scale quality assurance process has led to an improvement in the proportion of appropriately assessed and treated patients. However, delays in pain care management and the proportion of patients with adequate pain relief should be improved.Contexte et objectifsL'objectif est d’évaluer la prise en charge (PEC) de la douleur en médecine d'urgence et d’évaluer l'efficacité des mesures correctrices mise en place.Programme50 SU volontaires (CHU, CHG, 1 hôpital des armées, 2 structures privées répartis sur le territoire national) se sont engagés dans une procédure d'assurance qualité comprenant une phase de lancement puis un audit de dossier rétrospectif initial (T0) suivi de mesures correctrices évaluées par 2 audits successif à 3 mois d'intervalle (T1 et T2). Chaque SU devait analyser à chaque audit 50 dossiers tirés au sort. Les patients inclus étaient des adultes > 15 ans se présentant au SU, aucun facteur d'exclusion. Etaient recueillis: Les caractéristiques générales du patient, les pathologies, la présence ou non d'une douleur comme motif de recours, la présence d'une évaluation de l'intensité de la douleur (ID) à l'admission et ...