Nożewski Jakub, Bondarczuk Radosław, Hołody Grzegorz, Kitt Meabh, Mućka Natalia, Religioni Urszula
Department of Emergency Medicine, Dr Jan Biziel's University Hospital No. 2, 85-168 Bydgoszcz, Poland.
Lean Medic Foundation, Ul. Władysława Łokietka 24, 05-230 Kobyłka, Poland.
J Clin Med. 2025 Jun 27;14(13):4566. doi: 10.3390/jcm14134566.
: Pain remains as a prevailing cause, prompting patients to seek medical attention, comprising approximately 40% of all emergency department (ED) visits annually. Timely and effective pain management is crucial for patient comfort, satisfaction, and optimal recovery. However, there is increasing evidence highlighting the concern that patients often receive inadequate pain management in both emergency departments and prehospital settings. Despite the simplicity and potential for the repetitive use of pain scales throughout a patient's stay, it appears that a greater emphasis is often placed on monitoring hypotension or low saturation values rather than addressing pain levels above 7 on the numeric rating pain scale. : This article represents an ambitious attempt to implement process improvement methodologies such as Lean Management and SixSigma, both which have been well established in service and industrial fields, within the hospital environment to improve the process of pain management in the emergency department. : The implementation of pain management improvement processes in the emergency department led to a statistically significant but clinically modest increase in the administration of analgesics and improved pain reporting practices. The percentage of patients receiving no analgesia decreased from 96.6% to 94.8% ( = 0.008), and the documentation of pain characteristics during triage improved. However, the escalation of pain therapy remained limited, and strong analgesics were still underutilized. : Despite partial improvements, the lean management-based interventions did not sufficiently address the problem of oligoanalgesia in the emergency setting. Sustainable change requires enhanced clinical engagement, ongoing staff training, and the broader adoption of structured analgesia protocols across prehospital and hospital care.
疼痛仍然是一个普遍的病因，促使患者寻求医疗救治，每年约占所有急诊科就诊病例的40%。及时有效的疼痛管理对于患者的舒适度、满意度和最佳康复至关重要。然而，越来越多的证据表明，在急诊科和院前环境中，患者常常得不到充分的疼痛管理。尽管在患者住院期间使用疼痛量表简单且可重复，但似乎往往更强调监测低血压或低饱和度值，而不是处理数字评分疼痛量表上高于7级的疼痛水平。
本文是一次大胆的尝试，旨在将精益管理和六西格玛等在服务和工业领域已成熟的过程改进方法应用于医院环境，以改善急诊科的疼痛管理流程。
急诊科疼痛管理改进流程的实施在镇痛药的使用上带来了统计学上显著但临床上适度的增加，并改善了疼痛报告做法。未接受任何镇痛药治疗的患者比例从96.6%降至94.8%（P = 0.008），分诊期间疼痛特征的记录得到改善。然而，疼痛治疗的升级仍然有限，强效镇痛药仍未得到充分利用。
尽管有部分改善，但基于精益管理的干预措施未能充分解决急诊环境中镇痛不足的问题。可持续的改变需要加强临床参与、持续的员工培训，以及在院前和医院护理中更广泛地采用结构化镇痛方案。
