Managing Patients' Pain Improves Satisfaction, Revenue
Gilligan says the hospital would score much higher if it weren't "very conservative with using narcotics for noncancer pain." Some patients say the hospital "doesn't listen to me" when they ask for more powerful drugs, he says. Still, the hospital's pain management center maintains its conservative approach.
Other hospital officials acknowledge that they, too, would get better satisfaction scores if they catered more to patients' requests for more drugs to relieve their pain. "To get great patient outcome scores, a lot of patients might say, 'Give me more drugs,' right?" notes Patterson of the Northern Nevada Medical Center. "It's a juggling act. I want to make sure the patients who are coming in are not just doctor shopping or trying to get drugs," he adds.
"That's a hard part of pain management. Could I get better patient satisfaction scores if I gave more opioids?" Patterson asks, perhaps rhetorically. "But after all, at the end of the day, I've got to do what's medically appropriate; I've got to sleep at night."
At the hospital, Patterson says, "I think we have a reputation as the strictest in town. The 'drug-seeking patients,' they'll come in for easy meds. They say, 'No offense, you're too strict. I'll go somewhere else.' " He tells the patients, "Hey, good luck. Let me help you out the door."
Hospital procedures themselves cause pain. Each year, hospitals perform about 10 million inpatient surgeries and 17 million outpatient surgeries, all of which require pain management.
So how does a hospital improve its patient satisfaction scores when it comes to pain management? Within the past year, Barnes-Jewish Hospital has made inroads in patient satisfaction score improvements through changed protocols, especially involving anesthesiologists in a revised process of care, says Bottros.
It is important that pain management is developed for the appropriate pain condition and the type of surgery a patient has had. The hospital has made "simple" rather than drastic changes to improve patient satisfaction scores, Bottros says. Barnes-Jewish Hospital has anesthesiologists in a leadership role in pain management, which has been important for postoperative care and postoperative pain control.
"There's a growing trend for anesthesiologists to show their worth as perioperative physicians, not just in the operating room but in preoperative assessment and planning. It is using anesthesiologists in a more robust fashion," Bottros says.
The hospital focuses on consistent pain management, implementing a multidisciplinary team focus, with an emphasis on communication and proper protocols. For instance, the team consistently paces the use of epidurals for pain associated with surgeries, and acetaminophen is used, not just the
narcotics. It's important that the nursing staff consistently communicates with patients about their pain, and that message is directed to physicians.
The Barnes-Jewish Hospital has found ways to improve patient satisfaction scores dealing with pain. "In a very short time, the scores have increased robustly," Bottros says. In scores from patients who had gynecological surgery, patient satisfaction scores improved from 67% to 85% in two months in early 2013, he says.
Bottros noted that pain is sometimes difficult to control following surgery in orthopedics cases, such as knee replacement or hip pain. Yet those patient satisfaction scores also increased, from 55% to 83% for knee surgery, and 78% to 94% for hip surgery from September 2012 to April 2013.
Among colorectal surgical patients, for instance, patient satisfaction scores increased from 66% to 83.3% within the same six-month period, he says. "The only thing we changed is that we made sure the care path includes epidurals for perioperative pain, as well as other adjutant therapies."
In another area, knee replacement—where hospitals often have had difficulty achieving good scores among patients following surgery—the hospital's pain satisfaction scores jumped significantly from 55.4% to 83.3% from September 2012 to April 2013.
Because the reported improved patient satisfaction scores covered only a short period of time, Bottros concedes it's not a large, long-term sample. But he says the increased scores reflect the hospital's inroads into pain management and relief for patients.
"We try to ensure that we don't just stick to one particular technique," especially for postoperative pain management, he says. "For some surgeries, like abdominal, we use epidurals in combination with adjuvant medications such as IV acetaminophen or ketorolac, a nonsteroid anti-inflammatory drug," he adds. "For other surgeries, we use IV PCA [intravenous patient-controlled analgesia] in combination with adjuvant medications such as acetaminophen."
Patient attitudes about how hospitals control their pain is impacted by their perception of how the staff listens to them and cares about how they feel, with communication a key, Bottros says.
"I think in today's society, patients are a little less stoic than they might have been in the 1950s. Today people are more open to discussing their pain. Today patients are a lot more vocal about their problems and more vocal about their complaints," he says.
"If you improve pain management, you are also indirectly improving other aspects of patient satisfaction," Bottros says. "If a patient is happy with pain control, it does impact other scores as well."
Years ago, physicians were taught that pain control was "a symptom of some underlying disease, and as pain becomes more and more prevalent, and more chronic, that pain becomes a disease in itself," Bottros says. "We have started thinking outside the box a little bit, stopped trying to search for that elusive Pandora's Box, and now we're trying to accommodate patients."
This article appears in the September issue of HealthLeaders magazine.