Pain assessment and management in the emergency department: A prospective quasi-experimental study

Rapid assessment and treatment of pain is crucial when a patient first arrives in the emergency department (ED). Overcrowding and underassessment of pain can lead to inadequate management. There is also a paucity of literature on pain assessment and management practices in EDs. Hence, we decided to conduct a study to do a gap analysis on ongoing pain management practices in the ED and increase adherence to standard international pain management guidelines through a teaching program, with a vision for a "pain-free ED."

This quasi-experimental study examined ED patients with pain. The study was conducted in three phases: pre-training, training, and post-training. Observing the ED pain assessment and management practices was the primary objective. Patient demographics, pain assessment method, door-to-analgesia time, and the analgesic prescribed were recorded, among others. Training of residents and changes in pain management practices were secondary objectives.

Two hundred and forty-six patients were recruited in each of the pre-training and post-training phases. Before training, pain assessment was conducted in 19.5% of cases, primarily using the Numeric Rating Scale (NRS). Reassessment was done in only 22% of cases. Median door-to-analgesia time was 46.50 min, interquartile range (20-107). After training, pain assessment significantly improved from 19.5% to 59.8% (P = 0.0001). The rate of analgesic prescription at triage increased from 42.68% to 53.65% (P = 0.014). No significant change in door-to-analgesia time was observed (P = 0.091).

This study highlights deficiencies in current pain management practices in the ED and underscores the necessity for a structured departmental pain protocol. Recommendations include emphasizing pain assessment, documentation, and early prescription of correct analgesics. Positive outcomes in our study underscore the potential benefits of educational initiatives in optimizing pain management in the ED.