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Abstract
Background and Aims Postoperative acute pain management programmes (PAPMP) are known to be paramount for optimal quality of care1. A tailored adaptation of these programmes to centers’ clinical and financial realities is both essential and challenging and must be oriented towards patient satisfaction2.
This study aimed to assess the impact on quality of care and patient satisfaction following an update of a PAPMP in a tertiary Spanish hospital using a Delphi methodology3.
Methods A Strengths, Weaknesses, Opportunities, and Threats (SWOT) matrix analysis following a Delphy methodology was conducted. A European model-based structure was designed, structuring an open staff point-of-care oriented programme, based on procedure-specific (PROSPECT) protocolization4. Strategic and Clinical Quality Indicators in Postoperative Pain Managemet’ (SCQIPP) and Quality of Recovery 15 scores (QoR-15) were added as two main endpoints. Four months before the implementation these scores were collected for comparison purposes. Visual Analog Scale (VAS), QoR-15, and SCQIPP scores were compared between these two periods.
Results 400 surgical patients were followed (24% total knee replacement (TKR), 13% thoracic surgery, 13% laparotomy, and 6% Pfannenstiel incision). Epidural and femoral catheters were the most used regional analgesia techniques (58% and 27% respectively). A significant VAS reduction was found in Pfannenstiel, lumbar and hip surgeries, along with a significant QoR-15 reduction in lumbar, hip, and oncologic gynecologic surgeries. Significant increases in SCQIPP scores were found in TKR, Pfannenstiel, open nephrectomy, and hip replacement surgeries.
Conclusions A SWOT-Delphy quality-oriented design methodology in a PAPMP allows to obtain higher rates of reduction in pain control and improves patient quality perception.