“What is the patient experience of pain and pain management in the first three days after discharge from an acute surgical admission?”

Abstract

Introduction. The aim of this study is to explore the acute general surgical patients’ experience of pain and pain management three days after discharge. Length of hospital stay (LOS) is reducing due to advancing technological, pharmaceutical and surgical techniques. This is accompanied by fiscal pressure to ensure the health care dollar is spent prudently. The benefits of shortened length of hospital stay has been studied in some elective patient cohorts such as enhanced recovery after surgery (ERAS) and ambulatory surgery. Cochrane reviews searched to assess the effectiveness of shortened stay do not greatly detail pain or pain experience specifically but imply its existence in the body of the review associated with complications (Spanjersberg, Ruerings, Keus, & van Laarhoven, 2011). As pain is a natural consequence of disease or injury and poorly controlled pain contributes to poor patient satisfaction and development of chronic pain, knowledge of the patient experience seems beneficial to better patient outcomes. Little literature exists describing the patient’s experience of pain and pain management three days after discharge from an acute surgical admission. Methods. Qualitative inductive methodology with quantitative support data was used via a telephone interview on the third day after patients’ discharge following an acute surgical admission. Consecutive sampling was used to invite 39 general surgical patients, 25 of whom completed the interview. Participants came from two general surgical wards; one hepatobiliary and one colorectal, the wards also admitted trauma patients in Auckland City, New Zealand. Semi structured telephone interviews enabled recording of data which was transcribed by the researcher. Thematic analysis was used to identify themes in the data. Results. Thirty-nine patients were invited to participate of whom 30 accepted. Four participants were unable to be contacted and there was one late deletion. Of the 25 participants interviewed 13 were female, the average age of 54 years, range 22-88 years. Three main themes were identified; resilience, discontent and patient experience of discharge. Each theme was broken down into subthemes. Conclusions. Most patients managed their experience of pain and pain management well after discharge despite some having some challenges related to side effects, anxiety going home and uncertainty about reducing analgesia, some of which may be improved with greater focus on information sharing prior to discharge. This does not however negate the need for ongoing improvement in quality of service. There were a few patients whose pain was not managed to a level suitable for them. This study identifies the opportunity for improved communication and education about disease states and pain management between healthcare providers in acute care orgainsations and patients. Key words. Pain, experience, acute, surgical, discharge.