Improving management of acute pain for older adults in the ED setting

描述（由申请人提供）：随着人口老龄化，越来越多的老年人将出现紧急和痛苦的情况。初步研究表明，老年人不太可能在艾德环境中接受镇痛。在过去的十年中，在门诊和住院患者的疼痛护理干预措施取得了混合的成功，在提高质量和患者满意度的疼痛护理。提供临床决策支持（CDS）的干预措施是克服这一障碍的潜在方法，并可能为治疗老年人急性疼痛提供新的评估方法和管理策略，从而显着提高疼痛护理的质量。 本探索性试验研究的目的是确定将电子临床决策支持整合到艾德环境中老年人常规临床疼痛护理中的可行性， 确定这种临床决策支持是否有效地改善这些患者的疼痛护理结果。利用多阶段研究设计（结合可用性测试和定量研究方法），将收集数据以评估将CDS工具（包括电子疼痛护理警报（ePCA）干预和嵌入式疼痛护理算法）整合到常规艾德临床护理中的可行性。然后将研究一项评估这些有效性的随机比较有效性试验，以确定干预措施是否提高了疼痛护理的质量。CDS的创新使用，以前从未用于改善艾德环境中的老年疼痛护理，提示临床医生为主诉重度（腹部）疼痛（疼痛评分10/0-10疼痛量表）的老年患者提供急性疼痛护理，将与临床医生未收到警报（常规艾德）的对照患者进行比较 护理）。如果有效，这种干预措施的影响将对老年人特有的其他急性疼痛相关疾病产生广泛的影响和适用性，并在艾德内外的多种环境中观察到紧急情况，包括住院和门诊环境。 公共卫生相关性：这项探索性研究将评估临床决策支持工具的创新使用，该工具包括自动电子疼痛护理警报和嵌入式疼痛护理算法，以改善艾德环境中老年人的急性疼痛护理。如果可行且有效，这种干预可能不仅对改善老年疼痛护理质量，而且对改善艾德环境中老年人的一般护理质量产生广泛影响。

DESCRIPTION (provided by applicant): As the population ages, an increasing number of older adults will present to emergency departments (EDs) for urgent and painful conditions. Preliminary studies demonstrate that older adults are less likely to receive analgesia in the ED setting. Over the last decade, pain care interventions in the outpatient and inpatient settings have had mixed success in improving the quality and patient satisfaction of pain care received. Interventions that provide clinical decision support (CDS) are a potential method to overcome this barrier and may present new assessment methods and management strategies for treating acute pain in older adults, thus significantly improve the quality of pain care delivered. The goals of this exploratory pilot study are to determine the feasibility of integrating electronic clinical decision support into routine clinical pain care for older adults in the ED setting and to determine whether or not such clinical decision support is efficacious in improving pain care outcomes for these patients. Utilizing a multistage study design that incorporates usability testing and quantitative research methodologies, data will be collected to assess the feasibility of integrating a CDS tool consisting of both an electronic pain care alert (ePCA) intervention and an embedded pain care algorithm into routine ED clinical care. A randomized comparative effectiveness trial evaluating the efficacy of these will then be studied to determine if the intervention improves the quality of pain care. The innovative use of CDS, never previously used to improve geriatric pain care in the ED setting, to prompt clinicians to provide acute pain care to older patients with complaints of severe (abdominal) pain (pain score 10 out of 0-10 pain scale) will be compared to control patients seen by clinicians not receiving the alerts (routine ED care). If effective, the implications of such an intervention will have broad implications and applicability for other acute pain-associated conditions specific to older adults, and with urgent conditions seen in multiple settings across and external to the ED including inpatient and outpatient settings. PUBLIC HEALTH RELEVANCE: This exploratory study will evaluate the innovative use of a clinical decision support tool that consists of an automated electronic pain care alert and embedded pain care algorithms to improve acute pain care for older adults in the ED setting. If feasible and effective, such an intervention may have broad implications on improving not only the quality of geriatric pain care, but also general quality of care for elders in the ED setting.