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ORGANIZATION OF ACUTE PAIN SERVICES IN CANADIAN TEACHING HOSPITALS

Department of Anesthesiology, Queen's University, Kingston General Hospital, 76 Stuart St., Kingston, Ontario, K7L 2V7

INTRODUCTION

The purpose of this study is to determine how Acute Pain Management Services (APMS) are organized in academic hospitals across Canada.

METHODS

In June 2000, surveys were sent to 34 Directors of APMSs. By November 2000, 25 surveys had been returned (74%). Topics included: demographics, the structure and operations of APMSs, education, and data management.

RESULTS

The preliminary results are based on 25 hospitals in 7 of the 8 provinces with medical schools. 92% percent of the hospitals had over 200 beds. All of the APMSs were administered by Anesthesiology. 56% of the services had been in place for at least 10 years. 64% averaged more than 10 patients per day. 64% of hospitals had at least 1 anesthesiologist with fellowship training in either acute pain or regional anesthesia. In 64% of hospitals the anesthesiologists rotated through the APMS on a weekly basis.

Anesthesiologist performed rounds daily in 48% of hospitals and twice daily in 36 % of hospitals. Epidural patients were not restricted to monitored beds. 66% of patients remained on the service for at least 48 hours. In addition to covering the APMS, anesthesiologists also covered consults(48%), a regular OR day(40%), and obstetrics(20%). 28% were responsible for only APMS. All APMSs offered intravenous patient controlled analgesia(IVPCA), and many offered subcutaneous opiates, epidurals, spinal analgesia, nerve blocks and continuous infusions for peripheral blocks.

Data were collected primarily by the APMS nurse(54%) and/or anesthesiologist(60%), using a data collection tool 68% of the time. 28% had computerized data collection. The anesthesiologist recorded results on special data sheets(44%) and the progress notes(80%). 28% of hospitals collected data as part of an APMS database. 16% had assistance with data management.

Patient education was provided in 88% of centres, with pamphlets(92%), video(24%), and interview/discussion in pre-assessment(48%). 44% had a formal curriculum for residents, 80% for medical students and 32% for nursing students. 88% expressed an interest in being part of an APMS network.

DISCUSSION

The organization of APMSs vary. Few collect ongoing data and almost all are interested in becoming part of a network dedicated to treatment and research in acute pain management.

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