Optimising post-operative pain management
About 40 % of surgical patients suffer from moderate to severe post-operative pain, despite receiving treatment for it and despite the availability of comprehensive pain management guidelines. Such pain causes avoidable suffering, resulting in longer hospital stays and higher health care costs. Thus, the EU funded the 'Improvement in postoperative pain outcome' (PAIN OUT) project to study the problem. This project began in January 2009, with four-year funding, and as of 2013 will continue without EU funding. The project's main objective was to develop and validate a system for measuring outcome quality in terms of post-surgical pain. This took form as a pain registry, a large database incorporating and updating clinical data and subjective patient reports mostly from participating hospitals. As of 2012, it contained 35 000 records, making it one of the world's largest. The registry has two main purposes, first being quality improvement in the form of feedback (compared against other hospitals). Its second function is to facilitate health care research. Much of the project's work involved the technical establishment and population of the database. This included creation, validation and translation of a questionnaire supplied to hospitals, plus other modules of the registry such as the decision support system and electronic knowledge library: guidelines summarising current therapy recommendations. Major outcomes were the scientific results, covering three main areas. A health economics analysis indicated that a proportion of patients still suffer post-operative pain at the seven-day point, strongly affecting quality of life measures. A costing analysis of this data is underway. Other studies included a patient satisfaction survey. This survey revealed considerable variation in factors such as numbers of hospital visits and time committed by pain-team members causing variation in service among hospitals. Gender/age analysis revealed that some patients, especially older women, need extra attention for pain management. Rapid dissemination gained the project strong support, whereby it expanded to include 60 hospitals on 5 continents. The project's results were disseminated at 70 international meetings and 9 scientific publications to date. PAIN OUT's legacy will be improved pain management for patients, and savings for health care systems.
