Hospitalists Take Greater Role in Assessing and Treating Pain


A multidisciplinary pain-management research group at Mount Sinai School of Medicine in New York City has been evaluating numerical pain-rating scales, independent predictors of severe pain, their association with patient satisfaction rates, and improved inpatient pain outcomes resulting from targeted interventions with physicians. However, they found that while overall pain scores on medicine floors were lower than for surgical patients, they were also less responsive to the targeted interventions.

The group is piloting a program to promote pain champions in its department of medicine and encourage hospitalists to partner with nurses in focusing on pain assessment and treatment.

David L. Reich, MD, an anesthesiologist at Mount Sinai who leads the pain group, and colleagues recently published results from their research in the American Journal of Medical Quality.1 Pain increasingly will be an issue for hospitals and hospitalists, he says, with two pain-related questions now included on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey that is part of the government’s value-based purchasing initiative.

“It is our belief that unrelieved pain is an overall driver of other patient-reported metrics,” Dr. Reich says.

Andrew Dunn, MD, SFHM, head of the hospitalist service at Mount Sinai, acknowledges that medicine floors have been less successful at improving pain management, in part because the patient population is so much more heterogeneous.

“One thing that did not work was to have the pain team join medical rounds. That’s just not systematic or robust enough,” Dr. Dunn says. “We have piloted a program where patients’ pain scores are now delivered twice a day in reports to nurse managers and floor medical directors.”

Consecutive reports of pain scores of 5 or more (on a scale of 0 to 10) trigger consideration of a consultation with either the anesthesiology pain-management service or palliative-care service.


  1. Reich DL, Porter C, Levin MA, et al. Data-driven interdisciplinary interventions to improve inpatient pain management. Am J Med Q. 2012 Sept 25 [Epub ahead of print].

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