Doctors at the Mount Sinai Medical Center in New York City not only feel your pain, they can now reliably predict it. After an exhaustive review of more than 38,500 patients, the medical staff has implemented a plan it claims is lowering patients’ pain levels and raising satisfaction with their pain management.
By identifying patients at higher risk for pain prior to or upon their admission to the hospital, interdisciplinary teams create and implement pain management plans designed specifically for that patient’s needs.
“To our knowledge, this is the first time hospital-wide data on pain severity and levels of satisfaction with pain management have been reported,” said David L. Reich, MD, professor and chair of Mount Sinai’s Department of Anesthesiology. “While the factors that predict patients likely to experience higher levels of pain may not be surprising, we were able to show that awareness of and targeted responses to those factors decrease pain and increase patient satisfaction.”
For the initial phases of the study, researchers evaluated the clinical and administrative data of inpatients to identify a numeric scale of pain severity associated with patient satisfaction. Next, they developed a model to predict that metric of pain upon admission to the hospital.
Some of what they found was surprising. Patients who identified their pain during their hospital admission as moderate or severe were more likely to be younger, female and admitted for longer hospital stays. They were also more likely to be using psychoactive medications.
A patient’s level of pain was also found to vary depending on the department of the treating physician. Not surprisingly, patients who had surgery reported the greatest pain severity.
In Mount Sinai’s Department of Orthopedics, patients undergoing joint replacement reported on the first day of surgery an average pain level of five, on a scale of zero to ten. After the interdisciplinary team analyzed the data, they introduced new protocols altering the types of oral and intravenous pain medications the patients were being given. The average reported pain level decreased to three.
By using the results of that predictive model as a template, the pain management team developed and implemented what they describe as a practice-based and evidence-based intervention throughout the hospital.
“The involvement of our nurses and doctors at the bedside in this study is a strength and demonstrates our commitment to understanding and improving pain management,” said Carol Porter, chief nursing officer at Mt. Sinai.
That involvement seems to have had a positive outcome. From 2009 to 2010, pain levels decreased by 3.6% per quarter. Patient satisfaction also increased. No department reported that patients experienced increased pain during that period.
“The important point here is that institutions that use their available data and take an interdisciplinary approach to pain management can be successful in improving the patient experience,” said Dr. Reich.
The Mt. Sinai study was published online in the American Journal of Medical Quality.