Goodacre S W, Roden R K
Accident and Emergency Department, St Jame's University Hospital, Leeds.
J Accid Emerg Med. 1996 May;13(3):177-9. doi: 10.1136/emj.13.3.177.
To assess the use of analgesia in an accident and emergency (A&E) department and identify shortcomings.
University teaching hospital.
An audit of patients referred from the A&E department to orthopaedic fracture clinic (n = 100) or for orthopaedic admission (n = 100) was carried out to document analgesia use. An analgesia protocol was introduced and analgesia use was reassessed on the same numbers of patients.
Prescribing of analgesia was initially poor: 91% of fracture clinic referrals and 39% of admissions received no analgesia while in the A&E department; when given, it was often by inappropriate routes. Introduction of an analgesia protocol significantly improved analgesia use: fracture clinic referrals receiving unsatisfactory analgesia were reduced from 91% to 69% (P < 0.001). There was a marked increase in the use of intravenous analgesia, from 9% to 37% (P < 0.001).
Large numbers of patients still receive no analgesia while in the A&E department. This seems to be a common problem requiring intervention at a national level. The absence of a coordinated approach to improving analgesia provision for acute trauma in the United Kingdom should be addressed urgently.
评估急诊部门镇痛药物的使用情况并找出不足之处。
大学教学医院。
对从急诊部门转诊至骨科骨折诊所（n = 100）或需骨科住院治疗（n = 100）的患者进行审核，以记录镇痛药物的使用情况。引入了镇痛方案，并对相同数量的患者重新评估镇痛药物的使用情况。
最初镇痛药物的处方开具情况较差：在急诊部门时，91%转诊至骨折诊所的患者和39%需住院治疗的患者未接受任何镇痛治疗；即便给予了镇痛治疗，给药途径也常常不当。引入镇痛方案后，镇痛药物的使用情况有了显著改善：接受的镇痛效果不理想的转诊至骨折诊所的患者比例从91%降至69%（P < 0.001）。静脉镇痛药物的使用显著增加，从9%增至37%（P < 0.001）。
大量患者在急诊部门时仍未接受任何镇痛治疗。这似乎是一个常见问题，需要在国家层面进行干预。英国在改善急性创伤镇痛服务方面缺乏协调一致的方法这一问题应亟待解决。
