A Quality Control Program for Acute Pain Management in Out-of-Hospital Critical Care Medicine, ,

Study objective: This study was conducted to evaluate a quality control program for improving pain treatment in the out-of-hospital setting. Methods: Pain was evaluated for all patients at the beginning (T0) and the end (Tend) of out-of-hospital management. During the first part of the study (part 1, n=108), the administration and choice of analgesics was left to the physician’s discretion. Pain protocols were then modified to encourage the use of opioids. The effectiveness of this new pain management was analyzed (part 2, n=105) using pain scales and quality of relief. Results: Seventy percent of patients who expressed meaningful pain did not request analgesia, and 36% did not receive any analgesia in part 1 in contrast to 7% in part 2 of the study. The verbal rating scale and visual analog scale scores were substantially improved at Tend versus T0 in both periods, but the improvement was greater in part 2 (mean visual analog scale score at Tend was 29.3±23 mm [±SD]) than in part 1 (38.6±25 mm). The percentage of patients who expressed satisfactory relief increased in part 2 (67% versus 49% in part 1). The mean dose of intravenous morphine was 7.2±6 mg. Adverse effects were rare and minor. Conclusion: This program focusing on pain treatment plus implementation of pain protocols (with intravenous morphine) improved pain management in the field. [Ricard-Hibon A, Chollet C, Saada S, Loridant B, Marty J: A quality control program for acute pain management in out-of-hospital critical care medicine. Ann Emerg Med December 1999;34:738-744.]