Towards Better Perioperative Pain Management in Mexico: A Study in a Network of Hospitals Using Quality Improvement Methods from PAIN OUT

Abstract

Ana Lilia Garduño-López,1 Victor Manuel Acosta Nava,1 Lisette Castro Garcés,1 Dulce María Rascón-Martínez,2 Luis Felipe Cuellar-Guzmán,3 Maria Esther Flores-Villanueva,4 Elizabeth Villegas-Sotelo,5 Orlando Carrillo-Torres,6 Hugo Vilchis-Sámano,7 Mariana Calderón-Vidal,8 Gabriela Islas-Lagunas,9 C Richard Chapman,10 Marcus Komann,11 Winfried Meissner,11 Philipp Baumbach,11,* Ruth Zaslansky11,* 1Department of Anesthesiology, Instituto Nacional de Ciencias Médicas y Nutrición “Dr. Salvador Zubirán”, Mexico City, Mexico; 2Department of Anesthesiology, Centro Médico Nacional Siglo XXI, Mexico City, Mexico; 3Department of Anesthesiology, Instituto Nacional de Cancerología (INCAN), Mexico City, Mexico; 4Department of Anesthesiology, Hospital General Regional No. 2” Dr. Guillermo Fajardo Ortíz” IMSS (Villacoapa), Mexico City, Mexico; 5Department of Anesthesiology, Clínica Integral de Cirugía para la Obesidad y Enfermedades Metabólicas, Hospital General “Dr. Ruben Leñero”, Mexico City, Mexico; 6Department of Anesthesiology Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, Mexico; 7Department of Orthopedics & Traumatology, Unidad Médica de Alta Especialidad del Hospital de Traumatología y Ortopedia Lomas Verdes (IMSS), Mexico City, Mexico; 8Department of Anesthesiology Fundación Médica Sur, Mexico City, Mexico; 9Department of Anesthesiology Instituto Nacional de Enfermedades Respiratorias (INER), Mexico City, Mexico; 10Pain Research Center, Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA; 11Department of Anesthesiology and Intensive Care, Jena University Hospital, Jena, Germany*These authors contributed equally to this workCorrespondence: Ruth ZaslanskyDepartment of Anaesthesiology and Intensive Care, University Hospital Jena, Erlanger Allee 101, Jena, D 07740, GermanyTel [phone]Fax + 49 3641 9323112Email [email protected]: This was a pre–post study in a network of hospitals in Mexico-City, Mexico. Participants developed and implemented Quality Improvement (QI) interventions addressing perioperative pain management.Methods: PAIN OUT, an international QI and research network, provided tools for web-based auditing and feedback of pain management and patient-reported outcomes (PROs) in the clinical routine. Ward- and patient-level factors were evaluated with multi-level models. Change in proportion of patients reporting worst pain ≥ 6/10 between project phases was the primary outcome.Results: Participants created locally adapted resources for teaching and pain management, available to providers in the form of a website and a special issue of a national anesthesia journal. They offered teaching to anesthesiologists, surgeons, including residents, and nurses. Information was offered to patients and families. A total of 2658 patients were audited in 9 hospitals, between July 2016 and December 2018. Participants reported that the project made them aware of the importance of: training in pain management; auditing one’s own patients to learn about PROs and that QI requires collaboration between multi-disciplinary teams. Participants reported being unaware that their patients experienced severe pain and lacked information about pain treatment options. Worst pain decreased significantly between the two project phases, as did PROs related to pain interfering with movement, taking a deep breath/coughing or sleep. The opportunity of patients receiving information about their pain treatment options increased from 44% to 77%.Conclusions: Patients benefited from improved care and pain-related PROs. Clinicians appreciated gaining increased expertise in perioperative pain management and methods of QI.Keywords: acute pain, surgery, quality improvement, perioperative pain management, patient-reported outcomes, auditing

Keywords

• acute pain
• surgery
• quality improvement
• perioperative pain management
• patient reported outcomes
• auditing