Mapping the current state of pediatric surgical pain care across Canada and assessing readiness for change
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Published on: January 18, 2018
Kathryn A Birnie1,2,3, Jennifer Stinson4,5, Lisa Isaac6,7
1Department of Anesthesiology, Perioperative, and Pain Medicine, University of Calgary, Calgary, Alberta, Canada.
Insights
Improving pediatric surgical pain management is crucial. Canadian healthcare institutions need enhanced perioperative pain care to prevent chronic postsurgical pain in children.
Area of Science:
- Pediatric Surgery
- Pain Management
- Healthcare Systems
Background:
- Preventing chronic postsurgical pain in children is a priority for patients, caregivers, professionals, and policymakers.
- Inadequate management of presurgical and acute postsurgical pain increases the risk of developing chronic pain.
- Effective perioperative pain management is key to preventing the transition from acute to chronic pain.
Purpose of the Study:
- To identify current pediatric surgical pain management practices in Canada.
- To assess the readiness of Canadian healthcare institutions for implementing changes in pediatric surgical pain care.
Main Methods:
- An online survey was distributed to 85 multidisciplinary healthcare professionals across 20 Canadian health institutions.
- The survey collected data on institutional pre- and postsurgical pediatric pain care, specialty pain services, and Organizational Readiness for Implementing Change (ORIC).
Main Results:
- Acute and chronic/complex pain services were most prevalent, involving physicians and nurses.
- Alignment with recommended pediatric pre- and postsurgical pain care practices varied (38.1%-79.8%), with tertiary/quaternary children's hospitals showing less alignment.
- Inconsistent standards of care were identified as a significant gap, while healthcare professional experience was noted as a strength.
Conclusions:
- Canadian healthcare institutions require improvements in pediatric perioperative pain care.
- Enhanced pain management strategies are necessary to prevent the development of pediatric postsurgical pain.
Background:
Preventing pediatric chronic postsurgical pain is a patient, parent/caregiver, health care professional, and policymaker priority. Poorly managed presurgical and acute postsurgical pain are established risk factors for pediatric chronic postsurgical pain. Effective perioperative pain management is essential to prevent the transition from acute to chronic pain after surgery.
Aims:
The aim of this study was to identify current pediatric surgical pain management practices and assess health system readiness for change at health care institutions conducting pediatric surgery in Canada.
Methods:
An online survey was completed by 85 multidisciplinary health care professionals (nurses, surgeons, anesthesiologists, allied health) from 20 health institutions in Canada regarding institutional pre- and postsurgical pediatric pain care, specialty pain services, and Organizational Readiness for Implementing Change (ORIC).
Results:
Of all specialty pain services, acute and chronic/complex pain services were most common, primarily with physician and nursing involvement. Alignment to recommended practices for pediatric pre- and postsurgical pain care varied (38.1%-79.8% reported "yes, for every child"), with tertiary/quaternary children's hospitals reporting less alignment than other institutions (community/regional or rehabilitation hospitals, community treatment centers). No significant differences were reported between health care institutions serving pediatric populations only versus those also serving adults. Health care professional experience/practice was the most reported strength in pediatric surgical pain care, with inconsistent standard of care the most common gap. Participants "somewhat agreed" that their institutions were committed and capable of change in pediatric surgical pain care.
Conclusions:
There is a continued need to improve pediatric pain care during the perioperative period at Canadian health care institutions to effectively prevent the development of pediatric postsurgical pain.
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