Case Study: Using Data to Improve Patient Pain Management

ESO Staff

Quality improvement projects are an important element for EMS agencies wanting to improve care for their community, ensure their performance aligns with national standards, and keep their teams’ skills in top shape. The number on requirement for creating an effective project is starting with reliable data, and access to useful information is key in not only forming your plans for improvement, but checking progress and effectiveness in your changes.

Recently, Utah’s Gold Cross Ambulance undertook a quality improvement (QI) project focused on improving pain management for its patients, uncovering some surprising findings during the process, and working across the team to improve customer satisfaction and healing.

“We found a big portion of our patient complaints revolved around pain or had a pain factor to them,” explains Brooke Burton, NRP and quality director for most of the QI project. “It was something we could improve on that would touch a large number of patients in our system and improve both health and customer satisfaction.”

QI Project Parameters

The project looked specifically at patients with severe pain – rated 7 or higher on a 10-point scale – and whether efforts to reduce it were documented and a reduction noted. Their starting numbers varied a bit across the service’s five main areas statewide, so Gold Cross wanted to improve consistency and increase the percentage of patients reporting relief of pain by 30%.

The project tested a range of methods, including a training and education focus, coaching, new supporting materials developed with input from team members, and protocol changes. Tools like ESO Analytics offered timely reporting, highlighting missed opportunities for pain management (allowing for correction and follow up) as well as areas in which the project was gaining traction.

Surprising Discoveries

Naturally there are valid reasons to avoid giving certain medications to certain patients, including unstable vital signs and allergies. But by identifying specific occurrences and trends within the team, Gold Cross made some interesting discoveries. For example, the team soon identified a documentation issue: Some providers were recording their pain-management efforts in the narrative section of their PCR, rather than the box where it belonged.

“Part of it was getting our documentation in the right place to show we were doing this and were effective,” says Burton. “We were actually treating a lot more patients than the analytics said.”

An even more interesting insight came from quizzing providers about why they didn’t give pain meds: Some cited drug shortages. While Gold Cross had never run out of pain medications, and no one had instructed crews to triage patients’ pain-relief needs or conserve drugs, some providers perceived this as an issue and were preserving on their own.

“The fact that they kind of took that on themselves was really interesting; that’s not the way we expect them to think in the field,” says Burton. As a result, leaders reinforced that getting the drugs was management’s job, and providers should presume abundance and do all they can for their patient.

EMS Industry Comparisons

Gold Cross additionally received some interesting perspective during its attendance at the recent ESO Research Forum, where they were able to investigate national data on analgesia administration. They were surprised to learn that, nationwide, fewer than 1 in 10 patients in extreme pain from traumatic injuries got analgesic medication in the field.

“These were trauma patients with injuries, and only 9% on average got some type of analgesic pain management,” explains Burton. “So it’s interesting if you’re able to tap into some of that national data like ESO provides and see how you compare. I thought we had a lot of areas to improve. But when I saw the national numbers, we were actually doing far better than most geographic regions. We still wanted to improve, but I think it gave us a better perspective on how the industry as a whole is doing.”

Successful Results

While the pain management efforts for Gold Cross are ongoing, the initial results from its QI project have been largely successful. Two areas reached the improvement goal, with one far exceeding it (a protocol change helped push the rate of pain reduction to more than 50% from the starting company average). Other areas reached the goal but then backslid, prompting increased attention to maintenance. Gold Cross is confident that its ongoing efforts, with proper and careful monitoring, will continue to yield successful results and improve care and customer satisfaction in its community.


EMS agencies across the nation are using millions of combined records compiled in the ESO Index to not only develop a detailed national picture of the industry, but to set their own standards and improve their own systems. To learn more about how to use the Index and read two additional real-world case studies, download the full eBook now.

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