A survey of acute pain services in Germany and a discussion of international survey data

Abstract

Background and objectives: Acute pain services (APS) have been introduced worldwide to improve postoperative pain management. However, data are lacking on organization and quality of these services in Germany.

Methods: A questionnaire on postoperative pain management was mailed to 773 departments of anesthesiology. Practice was compared between hospitals with and without APS and between services that did or did not meet basic quality criteria (QC): personnel assigned for APS, policies during nights and weekends, written protocols of pain management, and regular assessment and documentation of pain scores at least once a day.

Results: With 446 responding hospitals, 161 operated an APS. Large hospitals organized an APS more frequently than smaller hospitals (P <.001). Staff being assigned for the APS comprised anesthesiologists in 68.3% and nurses in 23.6% of the departments. In total, only half of the APS complied with basic QC. Regular assessment and documentation of pain scores were the QC most often missing (46.6%). Patient-controlled analgesia (PCA) was performed in 93.8%, 74.1%, and 69.8% of the departments providing APS with QC, APS without QC, and no APS. Epidural analgesia (EA) was available in nearly all departments (96.9%). A total of 75.6% of the departments performed EA on general wards (with QC: 93.8%, without QC: 82.7%, and no APS: 68.4%, P <.001). Frequency of PCA and EA use was highest in hospitals providing an APS with QC.

Conclusions: As 50% of German APS do not comply with QC, we believe structured policies, as well as quality assurance measures, should be emphasized in the future. A comparison to international survey data showed that APS, in general, often do not consider QC.