Background: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) was created to compare health care facilities based on patient satisfaction measures including pain management. There is concern that quality improvement metrics focused on pain control may contribute to increased opioid prescription. In our study, we examined whether improved performance on a non-pharmacologic nursing intervention was associated with improved HCAHPS responses in regards to pain

Methods: Adult inpatients at a single academic medical center with admission dates from January to December 2017 were included. The nursing intervention studied was reassessment of pain response to analgesic medication. Reassessment was defined as a pain score recorded in the electronic medical record 15-60 minutes after intravenous analgesic administration or 30-90 minutes after oral analgesic administration. Patients were classified into categories of low (0-74.9%), moderate (75-89.9), and high (≥90%) reassessment frequency. The two HCAHPS pain domain questions used during the study period were “how often did the staff do everything they could to help with pain” and “how often was pain well-controlled”. Response options consisted of never, sometimes, usually, and always. We combined never, sometimes, and usually to dichotomize the HCAHPS. Chi-square analysis was used to test the relationships between reassessment frequency and dichotomized HCAHPS responses.

Results: Analgesic medications were administered to 6,091 inpatients. The frequency of timely nurse reassessment after analgesic administration was low in 3,076 (51%) patients, moderate in 1,476 (24%) patients, and high in 1,539 (25%) patients. There were 3,717 responses returned for the HCAHPS question “staff did everything” and 3,715 responses for “pain well-controlled.” We found an association between reassessment frequency and “staff did everything” (p<0.001; Table 1) and an association between reassessment frequency and “pain well-controlled” (p<0.001; Table 1).

Conclusions: We found that a non-pharmacologic nursing intervention was associated with improved patient experience with regards to pain. Timely pain reassessment after analgesic administration was associated with not only improved pain control, but also patient perception that pain was better addressed. This study was observational in nature and the interpretation of its results are limited by potential confounders and uncertain causation. Our results, however, suggest that non-pharmacologic interventions, particularly timely reassessment of pain after analgesic administration, may have positive impacts on inpatient pain control.

IMAGE 1: Table 1: Reassessment Frequency and HCAHPS Scores