Sussman Maya, Goodier Elizabeth, Fabri Izabella, Borrowman Jessica, Thomas Sarah, Guest Charlotte, Bantel Carsten
Acute Medicine, Heartlands Hospital NHS Foundation Trust, Birmingham, UK.
Department of Obstetrics and Gynaecology, Jersey General Hospital, Jersey, UK.
Br J Pain. 2017 Feb;11(1):36-45. doi: 10.1177/2049463716673667. Epub 2016 Oct 11.
In-hospital pain services (IPS) are commonplace, but evidence of efficacy is inadequate, and patients' pain management in any hospital ward remains problematic. This service evaluation aimed to measure the effect of a contemporary IPS, its appropriate use and cost-efficacy.
Records of 249 adults reviewed by the IPS in an inner London Teaching Hospital over an 8-month period were analysed for demographic data, interventions, workload and change in pain intensity measured by numerical rating scale (NRS). Non-parametric tests were used to evaluate differences between initial and final NRS. Spearman's rank correlation analysis was used to create a correlation matrix to evaluate associations between all identified independent variables with the change in NRS. All strongly correlated variables (ρ > 0.5) were subsequently included in a binary logistic regression analysis to identify predictors of pain resolution greater than 50% NRS and improvement rather than deterioration or no change in NRS. Finally, referral practice and cost of inappropriate referrals were estimated. Referrals were thought to be inappropriate when pain was not optimised by the referring team; they were identified using a set algorithm.
Initial median NRS and final median NRS were significantly different when a Wilcoxon signed-rank test was applied to the whole cohort; Z = -5.5 (p = 0.000). Subgroup analysis demonstrated no significant difference in the 'mild' pain group; z = -1.1 (p = 0.253). Regression analysis showed that for every unit increase in initial NRS, there was a 62% chance of general and a 33% chance of >50% improvement in final NRS. An estimated annual cost-saving potential of £1546 to £4558 was found in inappropriate referrals and patients experiencing no benefit from the service.
Results suggest that patients with moderate to severe pain benefit most from IPS input. Also pain management resources are often distributed inefficiently. Future research is required to develop algorithms for easy identification of potential treatment responders.
医院内疼痛服务（IPS）很常见，但疗效证据不足，且任何医院病房中患者的疼痛管理仍存在问题。这项服务评估旨在衡量当代IPS的效果、其合理使用情况和成本效益。
分析了伦敦市中心一家教学医院的IPS在8个月期间对249名成年人的评估记录，以获取人口统计学数据、干预措施、工作量以及通过数字评分量表（NRS）测量的疼痛强度变化。使用非参数检验评估初始和最终NRS之间的差异。使用斯皮尔曼等级相关分析创建相关矩阵，以评估所有确定的自变量与NRS变化之间的关联。随后将所有强相关变量（ρ>0.5）纳入二元逻辑回归分析，以确定疼痛缓解超过NRS 50%以及NRS改善而非恶化或无变化的预测因素。最后，估计了转诊实践和不适当转诊的成本。当转诊团队未优化疼痛时，转诊被认为是不适当的；使用一套既定算法来识别这些情况。
对整个队列应用Wilcoxon符号秩检验时，初始中位数NRS和最终中位数NRS有显著差异；Z = -5.5（p = 0.000）。亚组分析表明，“轻度”疼痛组无显著差异；z = -1.1（p = 0.253）。回归分析表明，初始NRS每增加一个单位，最终NRS总体改善的可能性为62%，改善超过50%的可能性为33%。在不适当转诊和未从该服务中受益的患者中，估计每年可节省1546至4558英镑的成本。
结果表明，中重度疼痛患者从IPS投入中获益最大。此外，疼痛管理资源往往分配效率低下。未来需要开展研究，以开发易于识别潜在治疗反应者的算法。
