Hospitalization due to acute exacerbation of chronic pain: An intervention study in a university hospital

Scandinavian Journal of Pain - Tập 17 - Trang 345-349 - 2017
Daniel W. Wheeler1,2,3, Sara Kinna2, Andrew Bell2, Peter J. Featherstone2,4, David J. Sapsford2, Sam P. Bass2
1University Division of Anaesthesia, University of Cambridge, Box 93, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom
2Department of Anaesthetics, Box 93, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom
3Department of Anaesthetics, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, United Kingdom
4John V Farman Intensive Care Unit, Box 17, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom

Tóm tắt

Abstract Background and aims Hospitalization as a result of acute exacerbation of complex chronic pain is a largely hidden problem, as patients are often admitted to hospital under a variety of specialities, and there is frequently no overarching inpatient chronic pain service dedicated to their management. Our institution had established an inpatient acute pain service overseen by pain physicians and staffed by specialist nurses that was intended to focus on the management of perioperative pain. We soon observed an increasing number of nurse-to-nurse referrals of non-surgical inpatients admitted with chronic pain. Some of these patients had seemingly intractable and highly complex pain problems, and consequently we initiated twice-weekly attending physician-led inpatient pain rounds to coordinate their management. From these referrals, we identified a cohort of 20 patients who were frequently hospitalized for long periods with exacerbations of chronic pain. We sought to establish whether the introduction of the physician-led inpatient pain ward round reduced the number and duration of hospitalizations, and costs of treatment. Methods We undertook a retrospective, observational, intervention cohort study. We recorded acute Emergency Department (ED) attendances, hospital admissions, and duration and costs of hospitalization of the cohort of 20 patients in the year before and year after introduction of the inpatient pain service. Results The patients’ mean age was 38.2 years (±standard deviation 13.8 years, range 18-68 years); 13 were women (65.0%). The mode number of ED attendances was 4 (range 2–15) pre-intervention, and 3 (range 0–9) afterwards (p = 0.116). The mode bed occupancy was 32 days (range 9–170 days) pre-intervention and 19 days (range 0–115 days) afterwards (p = 0.215). The total cost of treating the cohort over the 2-year study period was £733,010 (US$1.12m), comprising £429,479 (US$656,291) of bed costs and £303,531 (US$463,828) of investigation costs. The intervention did not achieve significant improvements in the total costs, bed costs or investigation costs. Conclusions Despite our attending physician-led intervention, the frequency, duration and very substantial costs of hospitalization of the cohort were not significantly reduced, suggesting that other strategies need to be identified to help these complex and vulnerable patients. Implications Frequent hospitalization with acute exacerbation of chronic pain is a largely hidden problem that has very substantial implications for patients, their carers and healthcare providers. Chronic pain services tend to focus on outpatient management. Breaking the cycle of frequent and recurrent hospitalization using multidisciplinary chronic pain management techniques has the potential to improvepatients’ quality of life and reduce hospital costs. Nonetheless, the complexity of these patients’chronic pain problems should not be underestimated and in some cases are very challenging totreat.

Tài liệu tham khảo

Classification of Chronic Pain. Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy. Pain Suppl 1986;3:S1–226.

Patel S, Kai J, Atha C, Avery A, Guo B, James M, Malins S, Sampson C, Stubley M, Morriss R. Clinical characteristics of persistent frequent attenders in primary care: case-control study. Fam Pract 2015;32:624–30.

Reid S, Wessely S, Crayford T, Hotopf M. Medically unexplained symptoms in frequent attenders of secondary health care: retrospective cohort study. BMJ 2001;322:767.

R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing Website; 2017. Available at: https://www.R-project.org [accessed July 27].

Jacob R, Wong ML, Hayhurst C, Watson P, Morrison C. Designing services for frequent attenders to the emergency department: a characterisation of this population to inform service design. Clin Med (Lond) 2016;16:325–9.

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Scandinavian Journal of Pain

Tập 17

345-349

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