Objective 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.
2 ha puesto a prueba los sistemas de salud en toda su extensión a lo largo del mundo. Se desconoce el impacto del estrés quirúrgico y de la anestesia sobre la predisposición a una nueva infección por COVID-19, o la exacerbación de la infección en un paciente infectado por este virus que se va a operar. Aunque la mortalidad de COVID-19 está entre 1-5%, la mayoría de las muertes han ocurrido en pacientes de edad avanzada con afecciones cardiopulmonares subyacentes, la mayoría de ellos hipertensos, diabéticos y con obesidad, por lo cual, se debe poner especial atención en su manejo. La preparación y planeación perioperatoria cuidadosa es clave para lograr con éxito una adecuada atención clínica y mantener la seguridad del equipo de salud en un momento difícil y de alto riesgo. Un papel adicional del anestesiólogo, considerando que es el médico con mayor experiencia en el manejo de la vía aérea, consiste en apoyar a los servicios de emergencia para la intubación endotraqueal de los pacientes que requieren apoyo ventilatorio, siendo un procedimiento con recomendaciones de protección muy específicas. Por lo tanto, existe un compromiso como especialistas de conocer el tema a fondo y protegernos, así como al equipo de profesionales de la salud que se exponen salvando vidas durante esta contingencia. ABSTRACT. Currently, the SARS-CoV-2 pandemic has put health systems to the test throughout their world. The impact of surgical stress and anesthesia on predisposition to a new COVID-19 infection or exacerbation of the infection in a COVID-19 infected patient to be operated on is unknown. Although COVID-19 mortality is between 1-5%, most deaths have occurred in elderly patients with underlying cardiopulmonary conditions, most of them hypertensive, diabetic and obese, therefore, it should be specially attention in its handling. Carefull perioperative preparation and planning is key in successfully achieving adequate clinical care and maintaining the safety of the health team in a difficult and high risk moment. An additional role for the anesthesiologist, considering that he has the most experience in the management of the airway, is to support the emergency services for endotracheal intubation of patients who require ventilatory support, being a procedure with very specific protection recommendations. Therefore, there is a commitment as specialists, to know the subject thoroughly and protect ourselves along with the health team involved in saving lives during this contingency.
Background: Postoperative pain is common at the global level, despite considerable attempts for improvement, reflecting the complexity of offering effective pain relief. In this study, clinicians from Mexico, China, and eight European countries evaluated perioperative pain practices and patient-reported outcomes (PROs) in their hospitals as a basis for carrying out quality improvement (QI) projects in each country.Methods: PAIN OUT, an international perioperative pain registry, provided standardized methodology for assessing management and multi-dimensional PROs on the first postoperative day, in patients undergoing orthopaedic, general surgery, obstetric & gynaecology or urological procedures.Results: Between 2017 and 2019, data obtained from 10,415 adult patients in 105 wards, qualified for analysis. At the ward level: 50% (median) of patients reported worst pain intensities ≥7/10 NRS, 25% spent ≥50% of the time in severe pain and 20-34% reported severe ratings for pain-related functional and emotional interference. Demographic variables, country and surgical discipline explained a small proportion of the variation in the PROs, leaving about 88% unexplained. Most treatment processes varied considerably between wards. Ward effects accounted for about 7% and 32% of variation in PROs and treatment processes, respectively. Conclusions:This comprehensive evaluation demonstrates that many patients in this international cohort reported poor pain-related PROs on the first postoperative day. PROs and treatments varied greatly. Most of the variance of the PROs could not be explained. The findings served as a basis for devising and implementing QI programmes in participating hospitals.Author names are listed in the acknowledgement section.
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