This is a paper on an important topic – considering the CMS quality measures coming up that will track time to pain medication for long bone fractures – that demonstrates a mandatory computer reminder improved pain treatment more than an educational campaign did.
This is a prospective study of 35,628 patients visiting an Australian emergency department in which they went through several phases of intervention, the most salient in their minds was requiring assessment of a pain score at triage. They started by simply observing their performance, then they altered their electronic medical record with a mandated input of the pain score at triage. After the mandated scoring, time to analgesia went from median of 123 minutes to 95 minutes. After the mandate phase, the ED staff underwent an education program regarding pain management in the ED – and the time to analgesia didn’t improve any further.
So, it is reasonable to infer that mandating the pain score at triage had the desired effect on decreasing time to analgesia. However, 95 minutes until analgesia is still terrible. It would be far more interesting of an article if it truly broke down all the times – such as time to triage, time to room, time to physician, time to analgesia order, etc., because there are a lot more data points to gather.
Additionally, it seems it might simply be higher yield if – in addition to asking pain in triage – they had a triage protocol to treat the pain immediately at that point, rather than later downstream.
“Mandatory Pain Scoring at Triage Reduces Time to Analgesia”
www.ncbi.nlm.nih.gov/pubmed/21908072
I have to agree most especially if you feel the horrible pain.
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I think that there's nothing wrong with taking pills when you feel excruciating pain.
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