Impact of a clinical encounter time protection program on pain management: a retrospective difference-in-difference...

Patient-centred care is a cornerstone for healthcare quality, leading many hospitals to implement programs that prioritize patient, even within time-constrained clinical environments. Effects of these programs are poorly evaluated.

This retrospective observational cohort study aims to evaluate the impact of a patient-centred initiative aimed at protecting clinical encounter time by enhancing communication, fostering shared decision-making, and minimizing care interruptions on the quality of pain management in hospitalized patients. Electronic health record data and a difference-in-differences estimator were used to examine changes in quality of pain management outcomes in over 15 000 patients across 80 000 hospital stays ranging from 2018 to 2022 in the University Hospitals of Geneva, Switzerland.Pain management quality was evaluated using timeliness of pain relief delivery, adequacy of pain documentation, and patient satisfaction with pain management. Data were compared in units who implemented the programs compared to matched control units to evaluate both the immediate and sustained effects of the program, accounting for potential selection and contamination biases.

The results demonstrated significant and sustained improvements in pain management quality in intervention units. Rates of timely painkiller administration increased significantly more in intervention units compared to control units (OR: 1.46, 95% CI: [1.37, 1.56]), with effects persisting over time. Pain documentation also showed significant improvement in intervention units (OR: 1.47, 95% CI: [1.15, 1.88]), although a minor initial decline was observed, likely due to temporary staffing disruptions during implementation. However, there was no significant improvement in patient-reported satisfaction with pain management, which may reflect limitations in survey sensitivity and response biases given the 53.3% response rate.

This patient-centred program effectively improved objective measures of pain management quality in a tertiary hospital setting. However, further research is needed to assess its impact on patient experience, as well as healthcare professional engagement and satisfaction. Insights from future studies could guide the development of similar patient-centred initiatives that aim to balance efficiency with high-quality patient care.