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Pain Research and Management
Volume 19, Issue 6, Pages e179-e190

Quality Indicators for the Assessment and Management of Pain in the Emergency Department: A Systematic Review

Antonia S Stang,1,2,3 Lisa Hartling,4,5 Cassandra Fera,6 David Johnson,1,3,7 and Samina Ali4,8,9

1Department of Pediatrics, University of Calgary, Canada
2Community Health Sciences, University of Calgary, Canada
3Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Canada
4Department of Pediatrics, University of Alberta, Canada
5Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada
6School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
7Departments of Physiology and Pharmacology, University of Calgary, Calgary, Canada
8Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Canada
9Women and Children's Health Research Institute, Edmonton, Alberta, Canada

Copyright © 2014 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


BACKGROUND: Evidence indicates that pain is undertreated in the emergency department (ED). The first step in improving the pain experience for ED patients is to accurately and systematically assess the actual care being provided. Identifying gaps in the assessment and treatment of pain and improving patient outcomes requires relevant, evidence-based performance measures.

OBJECTIVE: To systematically review the literature and identify quality indicators specific to the assessment and management of pain in the ED.

METHODS: Four major bibliographical databases were searched from January 1980 to December 2010, and relevant journals and conference proceedings were manually searched. Original research that described the development or collection of data on one or more quality indicators relevant to the assessment or management of pain in the ED was included.

RESULTS: The search identified 18,078 citations. Twenty-three articles were included: 15 observational (cohort) studies; three before-after studies; three audits; one quality indicator development study; and one survey. Methodological quality was moderate, with weaknesses in the reporting of study design and methodology. Twenty unique indicators were identified, with the majority (16 of 20) measuring care processes. Overall, 91% (21 of 23) of the studies reported indicators for the assessment or management of presenting pain, as opposed to procedural pain. Three of the studies included children; however, none of the indicators were developed specifically for a pediatric population.

CONCLUSION: Gaps in the existing literature include a lack of measures reflecting procedural pain, patient outcomes and the pediatric population. Future efforts should focus on developing indicators specific to these key areas.