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

描述(申请人提供)：随着人口老龄化，越来越多的老年人将因紧急和痛苦的情况向急诊科(ED)提出申请。初步研究表明，老年人在ED环境中接受止痛的可能性较小。在过去的十年中，门诊和住院环境中的疼痛护理干预在提高疼痛护理的质量和患者满意度方面取得了喜忧参半的成功。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，从而显著提高疼痛护理的质量。这项探索性先导研究的目标是确定在ED环境下将电子临床决策支持整合到老年人常规临床疼痛护理中的可行性，并 确定这种临床决策支持在改善这些患者的疼痛护理结果方面是否有效。利用融合了可用性测试和定量研究方法的多阶段研究设计，将收集数据以评估将包含电子疼痛护理警报(EPCA)干预和嵌入式疼痛护理算法的CDS工具整合到常规急诊临床护理中的可行性。然后将研究一项评估这些药物疗效的随机比较有效性试验，以确定干预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急诊室中的老年疼痛护理，以促使临床医生向主诉严重(腹部)疼痛(疼痛评分10分)的老年患者提供急性疼痛护理，将与未收到警报的临床医生看到的对照患者进行比较(常规ED 关爱)。如果有效，这种干预措施的影响将对其他特定于老年人的急性疼痛相关疾病产生广泛的影响和适用性，并在急诊室内外的多个环境中出现紧急情况，包括住院和门诊环境。

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.