Evidence Based Anesthesia

The traditional APS team emerged in the late 1980’s with the first established team within the United States at the University of Washington in 1985. With success documented in a 1988 paper, APS teams became more prominent in the 1990s and were promoted by joint commission in 2001.

A dedicated APS ensures consistent, high-quality pain management. It helps prevent undertreatment of pain, which can lead to longer hospital stays, increased risk of complications like pneumonia and blood clots, and a slower recovery.

APS teams primarily led by anesthesia providers for their skills in regional, epidural, and neuraxial techniques. However, pharmacists, nurses, physical therapists and occupational therapists are equally important.

The scope of each APS team will be determined by each institution and hospital policy leading to significant variations on scope. In general, APS providers will perform regional, epidural and neuraxial procedures to relieve pain and follow these patients throughout the hospital stay to offer their education and expertise; they are also highly trained in multi-modal techniques to reduce reliance on opioids.

While internal medicine and surgical teams generally offer opioid based pain plans, an APS provides specialized, round-the-clock expertise for complex pain cases. They use advanced techniques like nerve blocks and patient-controlled analgesia (PCA) and offer expert guidance to the general nursing staff.

By providing effective pain relief, an APS can lead to earlier patient mobilization, shorter hospital stays, reduced post-operative complications, and higher patient satisfaction scores.

Unfortunately, no. While these providers are highly specialized in pain management and offer significant benefits to the patients, insurers, and hospitals, they can be seen as resource intensive

APS teams manage patients with moderate to severe acute pain, including those undergoing major surgery (e.g., orthopedic, thoracic, abdominal), patients with traumatic injuries, and medical patients with complex multifactorial origins of pain.

Yes, despite the initial setup costs, an APS can be cost-effective. By reducing the length of hospital stays and decreasing complication rates, it can lower overall healthcare costs per patient. It also boosts a hospital’s reputation, attracting more patients and skilled staff.

Administrators are crucial for securing funding, allocating resources (staff, equipment), establishing clear protocols and policies, and promoting the APS as a key hospital service to staff and the community.

An APS promotes multimodal analgesia, which uses a combination of drugs and techniques to reduce the reliance on opioids. This strategy helps to minimize side effects, reduce the total dose of opioids, and lower the risk of opioid dependence.

Integration requires clear communication and collaboration with surgical departments, nursing leadership, pharmacy, and physical therapy. The APS should have clear admission and discharge criteria and well-defined roles within the hospital’s clinical pathways.

Key metrics may include pain scores, length of hospital stay, rate of post-operative complications, patient satisfaction scores, and opioid consumption.

Offering a strong APS is a differentiator that highlights a hospital’s commitment to patient-centered care and leads to improved outcomes. This can attract more surgeons and patients, especially those undergoing major procedures where pain management is a primary concern.

Challenges include initial funding, securing specialized staff, establishing interdepartmental cooperation, and resistance to change from existing staff. A clear business plan and strong administrative support are vital to overcoming these hurdles.

APS teams significantly impact HCAHPS scores by improving patient satisfaction with pain management, communication, and overall hospital experience. Although the pain management questions were removed from the Hospital Value-Based Purchasing (VBP) program, effective pain control remains a crucial component of the overall patient experience and perception of care quality.

No single indicator is utilized for consultation, however, complex pain syndromes causing persistently high pain scores or when a patient exhibiting or patient dissatisfaction with pain management may also necessitate a consult to the APS team.

This is a gray area as there can be significant overlap of specialty between these services. -APS is usually associated with acute surgical pain, traumatic pain, acute on chronic pain, and acute pain related to cancer. However, they also see patients with complex medical illnesses associated with pain -Chronic Pain Services is often consulted for patients with acute on chronic pain, complex chronic pain states, cancer related pain, patients with implanted pain modulation devices, and when interventional pain management techniques may be necessary (ablations, intrathecal catheters, SCS, etc.). -Palliative Care Services is typically consulted when a life limiting illness (e.g., advanced cancer) with significant pain is difficult to control.

An acute pain service can: reduce hospital length of stay, decrease readmissions and complications, combat opioid crisis through multi-modal analgesia techniques, increase HCAHPS scores, address complicated pain etiologies, enhance hospital reputation, and improve patient experience.

Yes. Patients with pre-existing chronic pain are at higher risk for poor postoperative pain management, which can lead to the transition of acute post-surgical pain into further chronic pain (persistent postsurgical pain).