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. 2021 Sep 28;21(1):1021.
doi: 10.1186/s12913-021-07031-w.

Facilitators and barriers to post-discharge pain assessment and triage: a qualitative study of nurses' and patients' perspectives

Jinying Chen  1 , Jessica G Wijesundara  2 , Angela Patterson  2 , Sarah L Cutrona  2 , Sandra Aiello  3 , David D McManus  4 , M Diane McKee  5 , Bo Wang  2 , Thomas K Houston  6
Affiliations

Facilitators and barriers to post-discharge pain assessment and triage: a qualitative study of nurses' and patients' perspectives

Jinying Chen et al. BMC Health Serv Res. .

Abstract

Background: After hospital discharge, patients can experience symptoms prompting them to seek acute medical attention. Early evaluation of patients' post-discharge symptoms by healthcare providers may improve appropriate healthcare utilization and patient safety. Post-discharge follow-up phone calls, which are used for routine transitional care in U.S. hospitals, serve as an important channel for provider-patient communication about symptoms. This study aimed to assess the facilitators and barriers to evaluating and triaging pain symptoms in cardiovascular patients through follow-up phone calls after their discharge from a large healthcare system in Central Massachusetts. We also discuss strategies that may help address the identified barriers.

Methods: Guided by the Practical, Robust, Implementation and Sustainability Model (PRISM), we completed semi-structured interviews with 7 nurses and 16 patients in 2020. Selected nurses conducted (or supervised) post-discharge follow-up calls on behalf of 5 clinical teams (2 primary care; 3 cardiology). We used thematic analysis to identify themes from interviews and mapped them to the domains of the PRISM model.

Results: Participants described common facilitators and barriers related to the four domains of PRISM: Intervention (I), Recipients (R), Implementation and Sustainability Infrastructure (ISI), and External Environment (EE). Facilitators include: (1) patients being willing to receive provider follow-up (R); (2) nurses experienced in symptom assessment (R); (3) good care coordination within individual clinical teams (R); (4) electronic health record system and call templates to support follow-up calls (ISI); and (5) national and institutional policies to support post-discharge follow-up (EE). Barriers include: (1) limitations of conducting symptom assessment by provider-initiated follow-up calls (I); (2) difficulty connecting patients and providers in a timely manner (R); (3) suboptimal coordination for transitional care among primary care and cardiology providers (R); and (4) lack of emphasis on post-discharge follow-up call reimbursement among cardiology clinics (EE). Specific barriers for pain assessment include: (1) concerns with pain medication misuse (R); and (2) no standardized pain assessment and triage protocol (ISI).

Conclusions: Strategies to empower patients, facilitate timely patient-provider communication, and support care coordination regarding pain evaluation and treatment may reduce the barriers and improve processes and outcomes of pain assessment and triage.

Keywords: Cardiovascular disease; Natural language processing; Pain; Qualitative; Symptom assessment; Transitional care.

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Conflict of interest statement

Dr. McManus reports grants and personal fees from Bristol Myers Squibb, grants and personal fees from Pfizer, grants from Boehringer Ingelheim and Philips, non-financial support from Apple, personal fees and non-financial support from Samsung, grants and personal fees from Flexcon, personal fees from Avania, personal fees from Rose Consulting, grants and personal fees from Heart Rhythm Society, personal fees and non-financial support from Fitbit, outside the submitted work. The remaining authors have declared no competing interests.

Figures

Fig. 1
Fig. 1
An example of using PRISM to link themes from provider and patient interviews
Fig. 2
Fig. 2
Overview of qualitative results. Full names of the themes: Facilitator 1 (F1): Patients are grateful for or willing to receive follow-up from providers. F2: Nurses have experiences and skills for assessing symptoms including pain symptoms. F3: Good coordination within clinical teams for post-discharge patient care including symptom assessment. F4: EHR system and templates for follow-up call. F5: Follow-up calls are supported by the CMS or institutional policies. Barrier 1 (B1): Symptom assessment has been part of current provider-initiated follow-up phone calls but the impact has been limited by factors such as competing priorities, coverage, and timing. B2: Providers and patients have difficulty reaching each other. B3: Concerns about pain medication misuse (pain specific). B4: Sub-optimal coordination across clinical teams for post-discharge patient care. B5: No standardized pain assessment and triage protocol for follow-up calls (pain specific). B6: Lack of emphasis on follow-up call reimbursement among cardiology clinics. Patients’ pain burden: Patients’ disease burden related to post-discharge pain symptoms
See this image and copyright information in PMC

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