Purple = Pain! Implementing an Epic Dashboard Pain Timer to Improve Management of Acute Pain in the Emergency Department

Purpose/Objectives: Management of pain has been identified as a key element of high-quality care in the emergency department (ED). Although quality measures have been identified, few improvement projects have systematically assessed the processes of pain assessment in the ED. We assembled a multidisciplinary group with the objective of increasing the percentage of patients in the ED with initial pain scores >/= 4 who had an improvement of pain score by at least 1 point prior to discharge or admission by 10% within 3 months.

Design/Methods: A process analysis and driver diagram identified pain assessment and reassessment as the key drivers in timely administration of pain medication. A color-coded pain timer on the nurses’ and providers’ EHR trackboards was developed. The pain timer is activated upon patients’ arrival and displays the number of minutes since their arrival or their last pain assessment. The timer is white for the first 30 minutes, then yellow for the ensuing 15 minutes, and becomes purple after 45 minutes have passed. The timer resets when a pain score is documented and turns off when the patient denies pain. The pain timer was implemented in the ED in December 2020. Nursing and provider education were provided.

Results: At baseline in November 2020, 32% of patients with pain scores >/= 4 had improvement prior to discharge/admission, By February 2021, this rate had increased to 43% and has been sustained, as represented by a sustained centerline shift from 32% to 40% in the outcome metric (see Figure). In addition, both the frequency of an initial pain assessment and reassessment improved by 8% and 15%, respectively, for patients during this time period. A subcohort consisting of patients with vaso-occlusive crises (VOC) due to sickle cell disease (SCD) who presented to the ED during this time frame was analyzed to determine if timeliness of administration of pain medications improved with this intervention. The percentage of SCD patients with VOC who received an intravenous opioid and ketorolac within 60 minutes of arrival improved from 54% to 69% during this time frame. Furthermore, the percentage of these patients whose final ED pain score was improved increased from 51% to 68%.

Conclusion/Discussion: Implementation of a pain timer on the nursing and provider EHR trackboard was successful in improving management of acute pain in a high-volume tertiary emergency department. Our data suggests that a pain timer increases the frequency of initial pain assessment and pain reassessment, leading to improved timeliness of pain medication administration and a resultant decrease in patients’ pain.