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Improving timely analgesia administration for musculoskeletal pain in the emergency department
Delays to adequate analgesia result in worse patient care, decreased patient and provider satisfaction and increased patient complaints. The leading presenting symptom to emergency departments (EDs) is pain, with approximately 34 000 such patients per year in our academic hospital ED and 3300 visits...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7011892/ https://www.ncbi.nlm.nih.gov/pubmed/31986116 http://dx.doi.org/10.1136/bmjoq-2019-000797 |
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author | Woolner, Victoria Ahluwalia, Reena Lum, Hilary Beane, Kevin Avelino, Jackie Chartier, Lucas B |
author_facet | Woolner, Victoria Ahluwalia, Reena Lum, Hilary Beane, Kevin Avelino, Jackie Chartier, Lucas B |
author_sort | Woolner, Victoria |
collection | PubMed |
description | Delays to adequate analgesia result in worse patient care, decreased patient and provider satisfaction and increased patient complaints. The leading presenting symptom to emergency departments (EDs) is pain, with approximately 34 000 such patients per year in our academic hospital ED and 3300 visits specific for musculoskeletal (MSK) injuries. Our aim was to reduce the time-to-analgesia (TTA; time from patient triage to receipt of analgesia) for patients with MSK pain in our ED by 55% (to under 60 min) in 9 months’ time (May 2018). Our outcome measures included mean TTA and ED length of stay (LOS). Process measures included rates of analgesia administration and of use of medical directives. We obtained weekly data capture for Statistical Process Control (SPC) charts, as well as Mann-Whitney U tests for before-and-after evaluation. We performed wide stakeholder engagement, root cause analyses and created a Pareto Diagram to inform Plan–Do–Study–Act (PDSA) cycles, which included: (1) nurse-initiated analgesia at triage; (2) a new triage documentation aid for medication administration; (3) a quick reference medical directive badge for nurses; and (4) weekly targeted feedback of the project’s progress at clinical team huddle. TTA decreased from 129 min (n=153) to 100 min (22.5%; n=87, p<0.05). Special cause variation was identified on the ED LOS SPC chart with nine values below the midline after the first PDSA. The number of patients that received any analgesia increased from 42% (n=372) to 47% (n=192; p=0.13) and those that received them via medical directives increased from 22% (n=154) to 44% (n=87; p<0.001). We achieved a significant reduction of TTA and an increased use of medical directives through front-line focused improvements. |
format | Online Article Text |
id | pubmed-7011892 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-70118922020-02-25 Improving timely analgesia administration for musculoskeletal pain in the emergency department Woolner, Victoria Ahluwalia, Reena Lum, Hilary Beane, Kevin Avelino, Jackie Chartier, Lucas B BMJ Open Qual Quality Improvement Programme Delays to adequate analgesia result in worse patient care, decreased patient and provider satisfaction and increased patient complaints. The leading presenting symptom to emergency departments (EDs) is pain, with approximately 34 000 such patients per year in our academic hospital ED and 3300 visits specific for musculoskeletal (MSK) injuries. Our aim was to reduce the time-to-analgesia (TTA; time from patient triage to receipt of analgesia) for patients with MSK pain in our ED by 55% (to under 60 min) in 9 months’ time (May 2018). Our outcome measures included mean TTA and ED length of stay (LOS). Process measures included rates of analgesia administration and of use of medical directives. We obtained weekly data capture for Statistical Process Control (SPC) charts, as well as Mann-Whitney U tests for before-and-after evaluation. We performed wide stakeholder engagement, root cause analyses and created a Pareto Diagram to inform Plan–Do–Study–Act (PDSA) cycles, which included: (1) nurse-initiated analgesia at triage; (2) a new triage documentation aid for medication administration; (3) a quick reference medical directive badge for nurses; and (4) weekly targeted feedback of the project’s progress at clinical team huddle. TTA decreased from 129 min (n=153) to 100 min (22.5%; n=87, p<0.05). Special cause variation was identified on the ED LOS SPC chart with nine values below the midline after the first PDSA. The number of patients that received any analgesia increased from 42% (n=372) to 47% (n=192; p=0.13) and those that received them via medical directives increased from 22% (n=154) to 44% (n=87; p<0.001). We achieved a significant reduction of TTA and an increased use of medical directives through front-line focused improvements. BMJ Publishing Group 2020-01-07 /pmc/articles/PMC7011892/ /pubmed/31986116 http://dx.doi.org/10.1136/bmjoq-2019-000797 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Quality Improvement Programme Woolner, Victoria Ahluwalia, Reena Lum, Hilary Beane, Kevin Avelino, Jackie Chartier, Lucas B Improving timely analgesia administration for musculoskeletal pain in the emergency department |
title | Improving timely analgesia administration for musculoskeletal pain in the emergency department |
title_full | Improving timely analgesia administration for musculoskeletal pain in the emergency department |
title_fullStr | Improving timely analgesia administration for musculoskeletal pain in the emergency department |
title_full_unstemmed | Improving timely analgesia administration for musculoskeletal pain in the emergency department |
title_short | Improving timely analgesia administration for musculoskeletal pain in the emergency department |
title_sort | improving timely analgesia administration for musculoskeletal pain in the emergency department |
topic | Quality Improvement Programme |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7011892/ https://www.ncbi.nlm.nih.gov/pubmed/31986116 http://dx.doi.org/10.1136/bmjoq-2019-000797 |
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