The NIHR Research Design Service is closed to new requests from 30 September 2023. We will continue to support our existing clients with existing projects up to 31 March 2024. If you have a question you can email us.
For support with any new project ideas please now contact the NIHR Research Support Service.

Dr Jason Smith

Consultant in Emergency Medicine
Plymouth Hospitals NHS Trust

The PASTIES project.

Emergency care doctors and nurses in Plymouth were awarded £250,000 funding from the NIHR Research for Patient Benefit (RfPB) Programme, obtained with RDS support.

Consultant in Emergency Medicine Jason Smith, and Mark Rockett, a Consultant in Pain Medicine, alongside Research Nurse Rosalyn Squire and other collaborators, used the money to run a trial over two and a half years in the Emergency Department at Plymouth’s Derriford Hospital to find out whether patients get more relief if they administer their own pain control.

The College of Emergency Medicine recommends that patients in severe pain should receive analgesia within 20 minutes of arrival in the Emergency Department (ED), with regular reassessment and further action as required. However, effective pain control is often not achieved and almost half of ED patients in a recent survey felt more could have been done to treat their pain.

Patient Controlled Analgesia (PCA) is routinely used in other hospital settings (most often post-operatively) where the patient is fitted with a syringe driver which allows them to control their own pain relief, depending on need. PCAs are safe and effective but their value in ED is unknown. The team from the ED at Derriford Hospital in Plymouth, working with the RDS, designed the trial to assess whether the use of PCAs in ED is an effective and cost-effective alternative to nurse-titrated analgesia: (PAin SoluTions In the Emergency Setting – PASTIES).

Jason, Mark and Rosalyn approached the RDS with the idea to evaluate the use of PCA in patients in pain in ED. Although simple in concept, there were both practical and methodological issues to be addressed (for example, what happens when the patient is transferred to the ward? How can pain be reliably recorded in this setting?). These and many other issues were discussed in depth at the RDS SW Residential Research Retreat in November 2009. The team returned to Plymouth with the essentials for a competitive grant application and a realistic plan to take the study forward. An application was submitted to the South West RfPB Committee in January 2010, with the successful outcome conveyed about six months later.

Although recruitment started slowly, the team were able to add additional sites to boost recruitment and the trial completed successfully within budget. The main findings were published in two papers in the BMJ, with a third article accepted by Anaesthesia.

At the time of receiving the good news about securing the grant, Dr Mark Rockett said "The Research Retreat and the RDS South West were critical in shaping a good idea into a successful RfPB grant application – we couldn't have done it without you”.

Dr Jason Smith, who led the project, added: “Without the RDS we would still be groping around in the dark rather than where we are, about to start recruiting 400 patients to a well-funded study, so thanks again for all the input.”

Like most NIHR-funded trials, the PASTIES project team are collaborating with a UK Clinical Research Collaboration-accredited trials unit. In this case, the Peninsula Clinical Trials Unit (PenCTU) have helped to develop the trial protocol and other essential documents, helped guide the team through IRAS and now help manage the study as well as providing expertise in CRF and database design, data management, and QA. A number of RDS staff also continued to work on the project, with this extra role funded from the research grant.