Pain is a subjective but critical clinical symptom and should be managed with the same urgency as other vital signs in the emergency department (ED). Delayed analgesia, particularly among patients triaged to lower-acuity areas, contributes to prolonged suffering and reduced patient satisfaction. This study evaluated the impact of a structured Quality Improvement (QI) initiative aimed at improving timeliness and effectiveness of pain management in the ED.

 

Objective

To reduce door-to-analgesia time by at least 25% from baseline and improve time to 50% reduction of initial pain score among adult ED patients with moderate to minor injuries.

 

Methods

A prospective QI study using Plan–Do–Study–Act (PDSA) cycles was conducted over 8 weeks in a tertiary care emergency department with a 3-tier triage system. Adults aged ≥18 years presenting with pain scores ≥1/10 were included. Baseline data were collected for 50 consecutive patients over 2 weeks. Interventions included staff education on pain as the “fifth vital sign,” early pain scoring, implementation of nurse-initiated analgesia protocols for selected conditions, visual reminders, and weekly performance feedback. Primary outcomes were door-to-analgesia time and time to 50% reduction in pain score. Secondary outcomes included pain documentation rates and patient satisfaction.

 

Results

Median door-to-analgesia time decreased from 46 minutes (IQR 19–114) at baseline to 12 minutes (IQR 4–32) post-intervention, representing a 73% reduction (p < 0.001). Mean time to 50% reduction in pain score improved by 30%. Triage pain documentation increased from 38% to 92%. Nurse-initiated analgesia utilization rose from 0% to 68%. Patient satisfaction scores improved from 2.9/5 to 4.6/5.

 

Conclusion

A structured, multidisciplinary QI approach significantly improved the timeliness and effectiveness of pain management in the ED. Treating pain as a vital sign and empowering nurses through standardized protocols enhanced efficiency, empathy, and patient satisfaction.