Prehospital pain treatment: an economic productivity factor in emergency medicine?

Abstract

Analgesia is a recommended practice for pain treatment in prehospital emergency medicine, but all experts note suboptimal pain relief or oligoanalgesia. The increase in the Care Workload (CW) and the Medical Treatment Duration (MTD) linked to analgesia are two explanatory factors, and they are representative of the unavailability of a prehospital team. The unavailability of a team is an opportunity cost which is probably the most important cost within the framework of prehospital emergency. The aim of this study was to analyse the influence of analgesia use on the availability of prehospital emergency teams. This study was a prospective, multicentre cohort study conducted in 10 French Mobile Emergency and Resuscitation Services (MERS) between September 2001 and June 2003. A case-control study was performed including 568 case patients who received analgesia matched with controls based on diagnosis and severity. The pairs were compared for MTD and CW. No significant difference between cases and controls was found concerning MTD (P = 0.134). Conversely, a difference was found for CW (P < 10(-4)), with a mean value of 53.7 Project Recherche Nursing (PRN) points for the cases and 45.8 PRN points for the controls. This study shows that analgesia generates an additional CW without increasing the MTD, and does not hinder the MERS teams' availability. This economic result should improve adherence to these clinical practice guidelines. Thus, analgesia appears to be a factor of productivity in the current context of economic pressures in terms of the funding of the healthcare system.