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Curr Med Res Opin. 2018 Jan;34(1):187-196. doi: 10.1080/03007995.2017.1391081. Epub 2017 Nov 15.

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

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a Dept. of Anesthesiology and Intensive Care , Jena University Hospital , Jena , Germany.
b University Hospital , Rotterdam , The Netherlands.
c Brandenburg Medical School - Theodor Fontane , Neuruppin , Germany.
d Faculty of Health - School of Medicine , Witten/Herdecke University , Witten , Germany.
e Institute of Nursing Science and Practice, WHO Collaborating Centre for Nursing Research and Education, Paracelsus Medical University , Salzburg , Austria.
f Brooks College of Health , University of North Florida, Jacksonville , Florida , USA.
g Département d'Anesthésie-Réanimation, Groupe Hospitalier Paris Sud , Hôpital Bicêtre , Le Kremlin-Bicêtre , France.
h SOS Regional Anaesthesia (SOS-RA) Service , Le Kremlin-Bicêtre , France.
i Neil Betteridge Associates , London , UK.
j Dept. Medical and Surgical Sciences and Biotechnologies, Unit of Anaesthesia, Intensive Care and Pain Medicine , Sapienza University of Rome - Polo Pontino , Latina , Italy.
k Anesthesia Critical Care and Pain Management Department , General University Hospital , Valencia , Spain.
l Department of Anaesthesia , Royal Surrey County Hospital , Guildford , UK.
m Faculty of Health and Medical Sciences , University of Surrey , Guildford , UK.
n Department of Anesthesiology and Critical Care , Hôpital Raymond-Poincaré , Garches , France.
o Pain Clinic, Department of Anaesthesiology, Intensive Care, and Pain Medicine , Helsinki University Hospital and University of Helsinki , Helsinki , Finland.
p Section for Surgical Pathophysiology, Rigshospitalet , Copenhagen , Denmark.
q The Leuven Centre for Algology & Pain Management , University of Leuven , Leuven , Belgium.
r Department of Anesthesiology , Hospitales Mar-Esperanza, Universitat Autònoma Barcelona , Barcelona , Spain.
s Naples Anesthesia and Pain Associates , Naples , Florida , USA.
t Charité University , Berlin , Germany.


Despite the introduction of evidence-based recommendations for postoperative pain management (POPM), the consensus is that pain control remains suboptimal. Barriers to achieving patient-satisfactory analgesia include deficient knowledge regarding POPM among staff, lack of instructions, insufficient pain assessments and sub-optimal treatment. Effective monitoring of POPM is essential to enable policy makers and healthcare providers to improve the quality of care. Quality indicators (QIs) are quantitative measures of clinical practice that can monitor, evaluate and guide the quality of care provided to patients. QIs can be used to assess various aspects relating to the care process and they have proven useful in improving health outcomes in diseases such as myocardial infarction. In this commentary we critically analyze the evidence regarding the use of QIs in acute POPM based upon the experience of pain specialists from Europe and the USA who are members of the Change Pain Advisory Board. We also undertook a literature review to see what has been published on QIs in acute pain with the goal of assessing which QIs have been developed and used, and which ones have been successful/unsuccessful. In the hospital sector the development and implementation of QIs is complex. The nature of POPM requires a highly trained, multidisciplinary team and it is at this level that major improvements can be made. Greater involvement of patients regarding pain management is also seen as a priority area for improving clinical outcomes. Changes in structure and processes to deliver high-level quality care need to be regularly audited to ensure translation into better outcomes. QIs can help drive this process by providing an indicator of current levels of performance. In addition, outcomes QIs can be used to benchmark levels of performance between different healthcare providers.


Analgesia; pain management; post-operative acute pain; quality indicators; quality management

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