Emergency Medicine and Trauma, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Emergency Medicine, Indira Gandhi Medical College and Research Institute, Puducherry, India.
BMJ Open Qual. 2024 Jun 4;13(2):e002815. doi: 10.1136/bmjoq-2024-002815.
Pain, more frequently due to musculoskeletal injuries, is a prevalent concern in emergency departments (EDs). Timely analgesic administration is paramount in the acute setting of ED. Despite its importance, many EDs face challenges in pain management and present opportunities for improvement. This initiative aimed to expedite the administration of the first analgesic in patients with musculoskeletal pain in the ED.
Observations within our ED revealed that patients with musculoskeletal injuries triaged to yellow or green areas experienced prolonged waiting times, leading to delayed analgesic administration, thereby adversely affecting clinical care and patient satisfaction.
The aim of our quality improvement (QI) project was to reduce the time to administration of first analgesia by 30% from baseline, in patients with musculoskeletal injuries presenting to our academic ED, in a period of 8 weeks after the baseline phase.
A multidisciplinary QI team systematically applied Point-of-Care Quality Improvement and Plan-Do-Study-Act (PDSA) cycle methodologies. Process mapping and fishbone analyses identified the challenges in analgesia administration. Targeted interventions were iteratively refined through PDSA cycles.
Interventions such as pain score documentation at triage, fast-tracking of patients with moderate-to-severe pain, resident awareness sessions, a pain management protocol and prescription audits were executed during the PDSA cycles. Successful elements were reinforced and adjustments were made to address the identified challenges.
The median door-to-analgesia timing during the baseline phase was 55.5 min (IQR, 25.75-108 min). During the postintervention phase, the median was significantly reduced to 15 min (IQR, 5-37 min), exceeding the anticipated outcomes and indicating a substantial 73% reduction (p value <0.001) from baseline.
Implementing simple change ideas resulted in a substantial improvement in door-to-analgesia timing within the ED. These findings significantly contribute to ongoing discussions on the optimisation of pain management in emergency care.
疼痛，更多地是由于肌肉骨骼损伤引起的，是急诊科（EDs）普遍关注的问题。在 ED 的急性环境中，及时给予镇痛剂至关重要。尽管如此，许多 ED 在疼痛管理方面面临挑战，并提供了改进的机会。这项倡议旨在加快 ED 中肌肉骨骼疼痛患者的第一剂镇痛药的给药。
我们 ED 的观察结果显示，分诊到黄色或绿色区域的肌肉骨骼损伤患者等待时间延长，导致镇痛剂给药延迟，从而对临床护理和患者满意度产生不利影响。
我们的质量改进（QI）项目的目标是将我们学术 ED 中出现的肌肉骨骼损伤患者的第一剂镇痛剂给药时间从基线减少 30%，在基线阶段后 8 周内。
一个多学科的 QI 团队系统地应用了即时质量改进和计划-执行-研究-行动（PDSA）循环方法。流程映射和鱼骨分析确定了镇痛剂给药的挑战。通过 PDSA 循环迭代改进了有针对性的干预措施。
在 PDSA 循环中执行了诸如分诊时的疼痛评分记录、快速跟踪中度至重度疼痛的患者、住院医师意识会议、疼痛管理协议和处方审核等干预措施。成功的元素得到了加强，并对确定的挑战进行了调整。
基线阶段的门到镇痛时间中位数为 55.5 分钟（IQR，25.75-108 分钟）。在干预后阶段，中位数显著减少至 15 分钟（IQR，5-37 分钟），超过预期结果，并表明从基线减少了 73%（p 值<0.001）。
实施简单的变更思路，可显著改善 ED 中的门到镇痛时间。这些发现对正在进行的关于优化急诊疼痛管理的讨论做出了重要贡献。
