title: Can consistent benchmarking within a standardized pain management concept decrease postoperative pain after total hip arthroplasty? A prospective cohort study including 367 patients.
abstract: BACKGROUND
  The number of total hip replacement surgeries has steadily increased over recent years. Reduction in postoperative pain increases patient satisfaction and enables better mobilization. Thus, pain management needs to be continuously improved. Problems are often caused not only by medical issues but also by organization and hospital structure. The present study shows how the quality of pain management can be increased by implementing a standardized pain concept and simple, consistent, benchmarking.
  
  
  METHODS
  All patients included in the study had undergone total hip arthroplasty (THA). Outcome parameters were analyzed 24 hours after surgery by means of the questionnaires from the German-wide project "Quality Improvement in Postoperative Pain Management" (QUIPS). A pain nurse interviewed patients and continuously assessed outcome quality parameters. A multidisciplinary team of anesthetists, orthopedic surgeons, and nurses implemented a regular procedure of data analysis and internal benchmarking. The health care team was informed of any results, and suggested improvements. Every staff member involved in pain management participated in educational lessons, and a special pain nurse was trained in each ward.
  
  
  RESULTS
  From 2014 to 2015, 367 patients were included. The mean maximal pain score 24 hours after surgery was 4.0 (±3.0) on an 11-point numeric rating scale, and patient satisfaction was 9.0 (±1.2). Over time, the maximum pain score decreased (mean 3.0, ±2.0), whereas patient satisfaction significantly increased (mean 9.8, ±0.4;p<0.05). Among 49 anonymized hospitals, our clinic stayed on first rank in terms of lowest maximum pain and patient satisfaction over the period.
  
  
  CONCLUSIONS
  Results were already acceptable at the beginning of benchmarking a standardized pain management concept. But regular benchmarking, implementation of feedback mechanisms, and staff education made the pain management concept even more successful. Multidisciplinary teamwork and flexibility in adapting processes seem to be highly important for successful pain management.
authors.affiliation: Department of Orthopedics, University Medical Center Regensburg.
authors.forename: Achim
authors.initials: A
authors.lastname: Benditz
authors.affiliation: Department of Orthopedics, University Medical Center Regensburg.
authors.forename: Felix
authors.initials: F
authors.lastname: Greimel
authors.affiliation: Clinic for anesthesia, Asklepios Klinikum Bad Abbach, Bad Abbach.
authors.forename: Patrick
authors.initials: P
authors.lastname: Auer
authors.affiliation: Centre for Clinical Studies, University Medical Center Regensburg, Regensburg.
authors.forename: Florian
authors.initials: F
authors.lastname: Zeman
authors.affiliation: Department of Anesthesiology and Intensive Care, Jena University Hospital, Jena, Germany.
authors.forename: Antje
authors.initials: A
authors.lastname: Göttermann
authors.affiliation: Department of Orthopedics, University Medical Center Regensburg.
authors.forename: Joachim
authors.initials: J
authors.lastname: Grifka
authors.affiliation: Department of Anesthesiology and Intensive Care, Jena University Hospital, Jena, Germany.
authors.forename: Winfried
authors.initials: W
authors.lastname: Meissner
authors.affiliation: Department of Orthopedics, University Medical Center Regensburg.
authors.forename: Frederik
authors.initials: F
authors.lastname: von Kunow
keywords: benchmarking; pain management concept; postoperative pain; total hip arthroplasty