Pain Management Is Paramount to Patient Satisfaction

Realistic expectations, reassurance and multimodal analgesia are a recipe for success.

If you’re serious about superior patient satisfaction scores, then you need to be laser-focused on superior pain management. Realistic expectation-setting and proper preemptive analgesia are how to ensure your discharge times are short and your satisfaction scores are sky-high. A little extra investment to keep patients at ease and prevent or reduce pain before it occurs is much easier than managing it after a patient is in agony.

‘Verbal analgesia’

For Jay Horowitz, CRNA, APRN, president of Quality Anesthesia Care Corp. in Sarasota, Fla., pain management starts by addressing the fears patients have about coming into his facility for their surgeries. “Even though the ophthalmology cases I do aren’t painful, patients anticipate that they’re going to have some needle or knife jabbed into their eye,” says Mr. Horowitz, who also serves as chief CRNA at Newsom Eye, with locations in the Tampa, Fla., area. “Patients are scared, and they need to be reassured. For us, verbal analgesia is critical.”

The verbal analgesia that Mr. Horowitz provides ranges from reassurance (“I have the same lenses you’re getting, and you’re going to love them”) to humor to little extras that go a long way with his patients. For instance, he gives every patient who comes in for their initial visit a business card with his personal cell phone number on it — and they use it, too. “They might be nervous about the IV and need a valium on the way or have a question or concern about whether I’m in-network,” says Mr. Horowitz. “Preparing patients properly and treating them like they mean something to you is well worth it. It’s good medicine, and it’s good business.”

Realistic expectations

Reassurance is important, but providers also need to set realistic expectations about what the surgical procedure entails and how it will affect patients postoperatively. “Patients are often told that there will be minimal or no pain, which creates inappropriate expectation,” says Girish P. Joshi, MB, BS, MD, FFARCSI, professor at The University of Texas Southwestern Medical Center Dallas’ Department of Anesthesiology and Pain Management. “This leads to decreased patient satisfaction even if the pain is mild.”

Most patients relate pain control to the success of the surgery, especially after the initial postoperative period.
Vinod Dasa, MD

Combined with an evidence-based multimodal analgesia protocol, patient education is the most important aspect of improving the patient’s overall satisfaction with the procedure, believes Dr. Joshi. “It is imperative to set realistic patient expectations regarding specific goals for adequate pain control,” he says. “Patient education reduces patient anxiety, improves pain control and improves satisfaction.”

The key is to be as clear and specific as possible to remove the chances of patients misunderstanding what they will experience. Dr. Joshi says clarity comes from direct phrases such as, Some pain is normal. You should be able to walk and do light activity. Soreness will get better gradually, or We plan to reduce pain intensity to an acceptable level to improve function and allow ambulation, not a specific pain score.

Notice how the latter phrase specifically refutes any reliance on a pain score. “There is a major problem with repeated pain score evaluation. There is a concern of the power of suggestion,” says Dr. Joshi.

Deciding factor

All the reassurance and education in the world won’t make much of a difference if your facility does a poor job managing the level of pain that can be controlled. “Most patients relate pain control to the success of the surgery, especially after the initial postoperative period,” says Vinod Dasa, MD, professor of orthopedics at LSU Health New Orleans School of Medicine. “The better the pain control, the more differentiated the practice becomes from other practices.”

That level of pain control usually only comes from facilities where different departments are on the same page and working together. There needs to be buy-in and alignment to provide adequate pain relief within the facility and a strategy for post-discharge pain control. This creates an opportunity to deliver a higher level of differentiated care. “It takes a team to deliver optimal outcomes, so having anesthesia on board is of critical importance to enhanced outcomes,” notes Dr. Dasa.

A recent research paper led by Dr. Dasa about a novel surgical pain management strategy following total knee arthroplasty that provided pain relief without opioids showcases what the right strategy can do for patient satisfaction. “We were able to provide significant pain control with patient education and some new innovations in conjunction with anesthesia,” says Dr. Dasa. “Because of these enhanced outcomes, our patient satisfaction has significantly improved, causing a growth in our volume from word-of-mouth referrals, not only from patients but also from other stakeholders like nurses and therapists. Improving pain control can fundamentally change the trajectory of a practice.” For Dr. Joshi, proper pain management should center on evidence-based multimodal analgesia that includes a combination of acetaminophen and an NSAID or COX-2 specific inhibitor administered either preoperatively or intraoperatively, and continued as scheduled (round the clock) postoperatively, unless contraindicated. “Patients should also receive dexamethasone 8 mg IV after induction of anesthesia, unless contraindicated,” says Dr. Joshi. “Finally, all patients should receive local surgical site infiltration and/or regional anesthesia when appropriate.”

Evolving care

Top-rated ASCs and HOPDs understand that pain management should be dynamic, led by OR teams that are always looking to improve and evolve. With patient satisfaction as closely tied to superior pain control as it is, it just makes sense to keep striving to do more. OSM

Note: This three-part article series is supported by Hikma Pharmaceuticals.