Kone V, Lecomte F, Randriamanana D, Pourriat J-L, Claessens Y-E, Vidal-Trecan G
Public health unit: risk management and quality of care, Paris Centre University Hospital Group, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
Emergency department, Paris Centre University Hospital, AP-HP, 75014 Paris, France.
Rev Epidemiol Sante Publique. 2016 Apr;64(2):59-66. doi: 10.1016/j.respe.2015.11.010. Epub 2016 Mar 8.
Pain management and patient satisfaction were targeted in the emergency department of a Paris university hospital. In 1999, 77.0% of patients complained of pain on arrival and more than half of patients did not experience pain relief at discharge. The purpose of the study was to evaluate the outcomes of the implementation of a team piloting pain management on pain reduction and pain care satisfaction.
Two cross-sectional surveys (04/10/1999 to 19/10/1999 and 03/04/2007 to 18/04/2007) were conducted before and after a team piloting pain management was deployed in the emergency department. Consecutive patients age 18 years and older who visited the department suffering from pain were given structured questionnaires that validated scales scoring pain upon arrival and at discharge. Patients' files were analyzed using structured forms. The parameters associated with pain reduction and patient satisfaction were sought.
In 2007, 65.0% of patients had their pain relieved vs. 35.1% in 1999 (P<0.001); 60.2% were satisfied with the pain care received vs. 39.8%. Pain management (e.g. waiting time ≤ 20 min: 47.6% vs. 20.8%; interventions on pain before the physician's examination: 63.0% vs. 13.8%; and pain reassessment after intervention: 13.8% vs. 4.5%) improved. Both pain reduction and patient satisfaction were significantly associated with intervention before the physician's examination. Pain reduction was independently and positively associated with time of survey, triage level (depending on the severity of their condition), pain intensity on arrival, and negatively associated with discharge without hospitalization. Satisfaction was independently and positively associated with waiting time before examination (0-20 min) and the absence of procedural pain.
The implementation of a team piloting pain management seemed to have had positive effects on pain management in the emergency department. However, respectively, 56.2% and 39.8% of patients remained without pain relief and dissatisfied with pain management at the end of their visit.
巴黎一家大学医院的急诊科将疼痛管理和患者满意度作为目标。1999年，77.0%的患者在就诊时抱怨疼痛，超过一半的患者在出院时疼痛未得到缓解。本研究的目的是评估一个试点疼痛管理团队在减轻疼痛和提高疼痛护理满意度方面的实施效果。
在急诊科部署试点疼痛管理团队之前和之后进行了两次横断面调查（1999年10月4日至1999年10月19日和2007年4月3日至2007年4月18日）。对连续就诊且年龄在18岁及以上、因疼痛前来该科室的患者发放结构化问卷，问卷采用经过验证的量表对患者就诊时和出院时的疼痛进行评分。使用结构化表格对患者病历进行分析。寻找与疼痛减轻和患者满意度相关的参数。
2007年，65.0%的患者疼痛得到缓解，而1999年为35.1%（P<0.001）；60.2%的患者对所接受的疼痛护理感到满意，而1999年为39.8%。疼痛管理（例如等待时间≤20分钟：47.6%对20.8%；在医生检查前对疼痛进行干预：63.0%对13.8%；干预后进行疼痛重新评估：13.8%对4.5%）有所改善。疼痛减轻和患者满意度均与医生检查前的干预显著相关。疼痛减轻与调查时间、分诊级别（取决于病情严重程度）、就诊时的疼痛强度呈独立正相关，与未住院出院呈负相关。满意度与检查前的等待时间（0 - 20分钟）和无操作疼痛呈独立正相关。
试点疼痛管理团队的实施似乎对急诊科的疼痛管理产生了积极影响。然而，分别仍有56.2%和39.8%的患者在就诊结束时疼痛未得到缓解且对疼痛管理不满意。
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