Multiple criteria decision analysis approach to consider therapeutic innovations in the emergency department: The methoxyflurane organizational impact in acute trauma pain

Acute trauma pain is poorly managed in the emergency department (ED). The reasons are partly organizational: ED crowding and rare trauma care pathways contribute to oligoanalgesia. Anticipating the organizational impact of an innovative care procedure might facilitate the decision-making process and...

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Bibliographic Details
Published in:PloS one 2020-04, Vol.15 (4), p.e0231571-e0231571
Main Authors: Lvovschi, Virginie Eve, Maignan, Maxime, Tazarourte, Karim, Diallo, Mohamed Lamine, Hadjadj-Baillot, Caroline, Pons-Kerjean, Nathalie, Lapostolle, Frederic, Dussart, Claude
Format: Article
Language:English
Subjects:
Ambulatory care
Analgesics
Bernard, Claude (1813-1878)
Biology and Life Sciences
Computer simulation
Context
Decision analysis
Decision making
Drug stores
Economics
Emergency management
Emergency medical care
Emergency medical services
Emergency preparedness
Experts
Health economics
Hospitals
Innovations
Life Sciences
Medical innovations
Medicine and Health Sciences
Morphine
Multiple criterion
Neurobiology
Neurons and Cognition
Pain
Pain management
Patients
People and Places
Pharmaceutical sciences
Pharmacists
Pharmacology
Physicians
Professionals
Social Sciences
Trauma
Trauma care
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Summary:Acute trauma pain is poorly managed in the emergency department (ED). The reasons are partly organizational: ED crowding and rare trauma care pathways contribute to oligoanalgesia. Anticipating the organizational impact of an innovative care procedure might facilitate the decision-making process and help to optimize pain management. We used a multiple criteria decision analysis (MCDA) approach to consider the organizational impact of methoxyflurane (self-administered) in the ED, introduced alone or supported by a trauma care pathway. A MCDA experiment was designed for this specific context, 8 experts in emergency trauma care pathways (leading physicians and pharmacists working in French urban tertiary hospitals) were recruited. The study involved four steps: (i) Selection of organizational criteria for evaluating the innovation's impact; (ii) assessment of the relative weight of each criterion; (iii) choice of appropriate scenarios for exploring the organizational impact of MEOX under various contexts; and (iv) software-assisted simulation based on pairwise comparisons of the scenarios. The final outcome measure was the expected overall organizational impact of methoxyflurane on a 0-to-100 scale (score >50: positive impact). Nine organizational criteria were selected. "Mean length of stay in the ED" was the most weighted. Methoxyflurane alone obtained 59 as a total score, with a putative positive impact for eight criteria, and a neutral effect on one. When a trauma care pathway was introduced concomitantly, the impact of methoxyflurane was greater overall (score: 75) and for each individual criterion. Our model highlighted the putative positive organizational impact of methoxyflurane in the ED-particularly when supported by a trauma care pathway-and the relevance of expert consensus in this particular pharmacoeconomic context. The MCDA approach could be extended to other research fields and healthcare challenges in emergency medicine.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0231571