Management of acute pain in the postoperative setting: the importance of quality indicators

Figures & data

Figure 1. Patient-rated pain scores on the first day after surgery using a 0–10 numerical rating scale. Reproduced with permission from Gerbershagen et al.⁹.

Table 1. Quality indicators used in the management of postoperative pain.

Quality Indicators
Structural The ability of the health system to provide the resources needed to deliver clinical programs and services (buildings, number of beds, type of equipment, provision of training programs, guidelines, staffing levels [specialist staff], supplies and finances).	Process What did the provider do for the patient and how effectively was it performed. Process indicators measure the care activities performed by the healthcare provider.	Outcomes Outcomes indicators measure the effect of the care process on the health and well-being of the patient. They can be intermediate or long term.
Examples in POPM Dedicated pain nurses Creation of a 24/7 APS Regular revision of guidelines SOPs/protocols Access to PCA equipment Regular training programs	Examples in POPM Proportion of patients with pain assessments Timeliness of pain assessment Guideline adherence (ratio) Patients receiving preoperative information Number of training programs Patients receiving analgesia Timeliness of analgesia	Examples in POPM Pain intensity Timeliness of pain relief Morbidity/adverse effects Functional status/mobilization Health status/QoL/work status Patient satisfaction

Abbreviations. APS, acute pain service; PCA, patient-controlled analgesia; POPM, postoperative pain management; QoL, quality of life; SOP, standard operating procedures.

Table 2. Process-related quality indicators reported in a systematic review on the management of pain in the emergency department²¹.

Process-Related Quality Indicator [number of studies]	Finding
Pain Assessment
Patients with any documented pain assessment [5]	57%–94%
Patients with documented pain assessment (validated pain score) [1]	23%
Patients with physician-documented pain assessment [1]	85%–86%
Patients with documented pain reassessment after treatment [4]	32%–50%
Timeliness of pain assessment [2]	Mean 40 min to 174 min from arrival to triage
Timely reassessment of pain relief after treatment [4]	0%–55% of patients; mean 113 min
Pain assessment documented before discharge [2]	56% of sites
Patients with pain rated 0/10 at discharge [1]	8%
Pain Management
Patients administered any analgesia [9]	6%–79%
Patients with analgesia offered at triage [3]	18%–83%
Timely access to any analgesia [12]	Mean or median > min in 6 of 9 studies. 14%–81% of patients had a delay of ≥1 h from arrival to triage
Timely access to parenteral opioid analgesia	Median 0.8 h to a mean 68 min from arrival to triage
Elderly patients treated with meperidine	32.8%
Patients receiving appropriate analgesic dose	92%
Patients receiving analgesic by appropriate route	55%

Gerbershagen HJ, Aduckathil S, van Wijck AJ, et al. Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology 2013;118:934-44

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Stang AS, Hartling L, Fera C, et al. Quality indicators for the assessment and management of pain in the emergency department: a systematic review. Pain Res Manag 2014;19:e179-90

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