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  • National review of acute pain service utilization, models of care, and clinical practices within the Veterans Health Administration

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Original research
National review of acute pain service utilization, models of care, and clinical practices within the Veterans Health Administration
  1. Lauren Mahyar1,
  2. Andres Missair2,
  3. Michael J Buys3,
  4. Alex Kou4,5,
  5. Esther Benedetti de Marrero2,
  6. Friedhelm Sandbrink6,
  7. Christina M Matadial2 and
  8. Edward R Mariano4,5
  9. On behalf of the Veterans Affairs Acute Pain Medicine Committee
    1. 1 Anesthesiology Service, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
    2. 2 Anesthesiology Service, Bruce W Carter Department of Veterans Affairs Medical Center, Miami, Florida, USA
    3. 3 Anesthesiology Service, Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah, USA
    4. 4 Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
    5. 5 Anesthesiology, Perioperative and Pain Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
    6. 6 Washington DC Veterans Affairs Medical Center, Washington, District of Columbia, USA
    1. Correspondence to Dr Edward R Mariano, Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, CA 94304, USA; emariano{at}stanford.edu

    Abstract

    Introduction The Veterans Health Administration (VHA) is the largest healthcare network in the USA and has been a national leader in opioid safety for acute pain management. However, detailed information on the availability and characteristics of acute pain services within its facilities is lacking. We designed this project to assess the current state of acute pain services within the VHA.

    Methods A 50-question electronic survey developed by the VHA national acute pain medicine committee was emailed to anesthesiology service chiefs at 140 VHA surgical facilities within the USA. Data collected were analyzed by facility complexity level and service characteristics.

    Results Of the 140 VHA surgical facilities contacted, 84 (60%) completed the survey. Thirty-nine (46%) responding facilities had an acute pain service. The presence of an acute pain service was associated with higher facility complexity level designation. The most common staffing model was 2.0 full-time equivalents, which typically included at least one physician. Services performed most by formal acute pain programs included peripheral nerve catheters, inpatient consult services, and ward ketamine infusions.

    Conclusions Despite widespread efforts to promote opioid safety and improve pain management, the availability of dedicated acute pain services within the VHA is not universal. Higher complexity programs are more likely to have acute pain services, which may reflect differential resource distribution, but the barriers to implementation have not yet been fully explored.

    • Acute Pain
    • Postoperative Pain
    • REGIONAL ANESTHESIA

    Data availability statement

    All data relevant to the study are included in the article or uploaded as online supplemental information.

    https://doi.org/10.1136/rapm-2023-104610

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      Data availability statement

      All data relevant to the study are included in the article or uploaded as online supplemental information.

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      Footnotes

      • Twitter @EMARIANOMD

      • Collaborators Veterans Affairs Acute Pain Medicine Committee members Erik Baker, MD; Kimberlee Bayless, APRN; William Craig, CRNA; Douglas Criado, PharmD; Timothy Dawson, MD; Bing Feng, MD; Juliann Hobbs, MD; Jason Johanning, MD; Joseph Keck, CRNA; Leidi Paez, PharmD; Francisco Paula, APRN; Merci Udoji, MD; and Tomas Walsh, MD.

      • Contributors AM created the survey, collected data, interpreted data, contributed to writing the initial draft manuscript, revised the draft manuscript, and approved the final submitted manuscript. CM and FS conducted committee approvals, revised the draft manuscript, and approved the final submitted manuscript. AK analyzed data, interpreted data, contributed to writing the initial draft manuscript, revised the draft manuscript, and approved the final submitted manuscript. LM, MJB and ERM interpreted data, contributed to writing the initial draft manuscript, revised the draft manuscript, and approved the final submitted manuscript. EBdM revised the draft manuscript and approved the final submitted manuscript. ERM serves as the guarantor. The guarantor accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.