Factors Associated With High Levels of Patient Satisfaction With Pain Management

Authors

  • Jessica Shill,

    1. From the Department of Medicine (JS, BN) and the Department of Biostatistics (AMU), University of Melbourne (DMT), Melbourne, Victoria; and the Emergency Department (DMT, MY, JR) and the Pharmacy Department (SET), Austin Health, Melbourne, Victoria, Australia.
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  • David McD. Taylor MD,

    1. From the Department of Medicine (JS, BN) and the Department of Biostatistics (AMU), University of Melbourne (DMT), Melbourne, Victoria; and the Emergency Department (DMT, MY, JR) and the Pharmacy Department (SET), Austin Health, Melbourne, Victoria, Australia.
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  • Bryan Ngui,

    1. From the Department of Medicine (JS, BN) and the Department of Biostatistics (AMU), University of Melbourne (DMT), Melbourne, Victoria; and the Emergency Department (DMT, MY, JR) and the Pharmacy Department (SET), Austin Health, Melbourne, Victoria, Australia.
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  • Simone E. Taylor PharmD,

    1. From the Department of Medicine (JS, BN) and the Department of Biostatistics (AMU), University of Melbourne (DMT), Melbourne, Victoria; and the Emergency Department (DMT, MY, JR) and the Pharmacy Department (SET), Austin Health, Melbourne, Victoria, Australia.
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  • Antony M. Ugoni,

    1. From the Department of Medicine (JS, BN) and the Department of Biostatistics (AMU), University of Melbourne (DMT), Melbourne, Victoria; and the Emergency Department (DMT, MY, JR) and the Pharmacy Department (SET), Austin Health, Melbourne, Victoria, Australia.
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  • Michael Yeoh MBBS,

    1. From the Department of Medicine (JS, BN) and the Department of Biostatistics (AMU), University of Melbourne (DMT), Melbourne, Victoria; and the Emergency Department (DMT, MY, JR) and the Pharmacy Department (SET), Austin Health, Melbourne, Victoria, Australia.
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  • Joanna Richardson MBBS

    1. From the Department of Medicine (JS, BN) and the Department of Biostatistics (AMU), University of Melbourne (DMT), Melbourne, Victoria; and the Emergency Department (DMT, MY, JR) and the Pharmacy Department (SET), Austin Health, Melbourne, Victoria, Australia.
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  • Presented at the Australasian College for Emergency Medicine, Annual Scientific Meeting, Sydney, November 2011; and the 6th Mediterranean Emergency Medicine Congress, Kos, Greece, September 2011.

  • Awarded The Australasian College for Emergency Medicine Morson Taylor Award for the best project protocol by a Fellow of the College.

  • The authors have no relevant financial information or potential conflicts of interest to disclose.

  • Supervising Editor: James R. Miner, MD.

Address for correspondence and reprints: David McD. Taylor, MD; e-mail: david.taylor@austin.org.au.

Abstract

ACADEMIC EMERGENCY MEDICINE 2012; 19:1212–1215 © 2012 by the Society for Academic Emergency Medicine

Abstract

Objectives:  The objective was to determine, among emergency department (ED) patients, the factors associated with a high level of satisfaction with pain management.

Methods:  This was a prospective cohort study in a single ED. Consecutive adult patients, with triage pain scores of ≥4 (numerical rating scale = 0 to 10), were enrolled. Variables examined included demographics, presenting complaint, pain scores, nurse-initiated analgesia, analgesia administered, time to first analgesia, specific pain communication, and whether “adequate analgesia” was provided (defined as a decrease in pain score to <4 and a decrease from the triage pain score of ≥2). The level of patient satisfaction with their pain management (six-point scale: very unsatisfied to very satisfied) was determined by a blinded investigator 48 hours post discharge. Logistic regression analyses were undertaken.

Results:  Data were complete for 476 patients: mean (±standard deviation [SD]) age was 43.6 (±17.2) years, and 237 were males (49.8%, 95% confidence interval [CI] = 45.2% to 54.4%). A total of 190 (39.9%, 95% CI = 35.5% to 44.5%) patients were “very satisfied” with their pain management, and 207 (43.5%, 95% CI = 39.0% to 48.1%) patients received adequate analgesia. Three variables were associated with the patient being very satisfied: the provision of adequate analgesia (odds ratio [OR] = 7.8, 95% CI = 4.9 to 12.4), specific pain communication (OR = 2.3, 95% CI = 1.3 to 4.1), and oral opioid administration (OR = 2.0, 95% CI = 1.1 to 3.4). Notably, the provision of nurse-initiated analgesia to 211 patients (44.3%, 95% CI = 39.8% to 48.9%) and the short time to analgesia (median = 11.5 minutes; interquartile range [IQR] = 2.0 to 85.8 minutes) were not associated with being very satisfied.

Conclusions:  The receipt of adequate analgesia (as defined) is highly associated with patient satisfaction. This variable may serve as a clinically relevant and achievable target in the pursuit of best-practice pain management.

Abstract

Resumen

Objetivos:  Determinar, entre los pacientes de un servicio de urgencias (SU), los factores asociados con un alto nivel de satisfacción con el manejo del dolor.

Métodos:  Estudio de cohorte prospectivo en un único SU. Se incluyeron pacientes adultos consecutivos, con una puntuación de dolor en el triaje≥4 (escala numérica: 0 a 10). Las variables analizadas incluyeron variables demográficas, motivo de consulta, puntuaciones del dolor, analgesia iniciada por el enfermero, analgesia administrada, tiempo hasta la primera analgesia, comunicación específica del dolor y si la analgesia administrada fue la adecuada (definida como un descenso en la puntuación del dolor a < 4 y un descenso de la puntuación del dolor del triaje de ≥2). Se determinó el nivel de satisfacción del paciente con el manejo del dolor (escala de seis puntos: muy insatisfecho a muy satisfecho) por un investigador enmascarado a las 48 horas tras el alta. Se llevó a cabo un análisis de regresión logística.

Resultados:  Los datos se completaron en 476 pacientes: la edad media fue 43,6 años (desviación estándar: ±17,2 años), y 237 fueron hombres (49,8%, IC 95% = 45,2% a 54,4%). Ciento noventa (39,9%, IC 95% = 35,5% a 44,5%) pacientes estuvieron “muy satisfechos” con el manejo del dolor, y 207 (43,5%, IC 95% = 39,0% a 48,1%) de los pacientes consideraron que recibieron una “analgesia adecuada”. Tres variables se asociaron con que el paciente estuviera muy satisfecho: el proporcionar una “adecuada analgesia” (OR 7,8, IC 95% = 4,9 a 12,4), la comunicación específica del dolor (OR 2,3, IC 95% = 1,3 a 4,1), y la administración de opioides por vía oral (OR 2,0, IC 95% = 1,1 a 3,4). Particularmente, no se asoció con estar muy satisfecho ni la administración de analgesia iniciada por el enfermero a 211 pacientes (44,3%, IC 95% = 39,8% a 48,9%) ni el tiempo corto hasta la administración de la analgesia (mediana 11,5 minutos, RIC 2,0 a 85,8 minutos).

Conclusiones:  El recibir una “adecuada analgesia” (como se ha definido previamente) está asociado en un alto grado con la satisfacción del paciente. Esta variable puede servir como un objetivo asequible y clínicamente relevante en el ejercicio de la mejor práctica clínica en el manejo del dolor.

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