Use of quality-improvement methods to improve timeliness of analgesic delivery

Area of Science:

• Pediatric Emergency Medicine
• Quality Improvement Science
• Pain Management

Background:

• Pain management in emergency departments is often suboptimal, particularly for pediatric patients.
• Children with extremity fractures experience significant pain that requires timely intervention.
• Existing processes may lead to delays in analgesic administration.

Purpose of the Study:

• To reduce delays in opioid administration for children with extremity fractures in the emergency department.
• To apply improvement science and quality-improvement methods to optimize pain management.
• To identify and address critical factors influencing timely analgesic delivery.

Main Methods:

• A multidisciplinary team identified key drivers for pain management through literature review, stakeholder interviews, and expert consensus.
• An intervention, the orthopedic evaluation process, was developed based on identified key drivers.
• The intervention focused on standardizing triage, activating providers, aligning resources, and enabling parallel tasks.

Main Results:

• The orthopedic evaluation process simultaneously addressed four key drivers of care.
• Following implementation, 95% of pediatric patients with long-bone fractures received intravenous opioids within 45 minutes.
• This represents a significant improvement from the pre-intervention baseline of 20%.

Conclusions:

• Quality improvement and process improvement methodologies were effective in identifying critical factors for rapid opioid delivery.
• The implemented orthopedic evaluation process significantly improved the timeliness of analgesic administration for pediatric patients with extremity fractures.
• This systematic approach enhances pain management for children in emergency settings.