A prospective audit of 225 children was conducted to evaluate current pain management strategies both in-hospital and at home following day surgery at British Columbia Children's Hospital (Vancouver, British Columbia). Anesthetic, postanesthetic care unit and surgical day care unit records were collected to generate in-hospital data. A telephone questionnaire was administered 48 h postdischarge for at home data. Pain reports and scores were significantly higher (P<0.01) at home compared with in-hospital. Children undergoing certain procedures were more likely to experience significant pain. Although good pain control was commonly achieved after surgery, improvements may be possible by increasing the use of multimodal analgesia, providing standardized written discharge instructions and using surgery-specific pediatric analgesia guidelines.

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Pain is a subjective experience that is affected by physical, emotional, and psychological factors, and reliable assessment of pain can be a challenge in the pediatric population. A quality improvement project was conducted at one Canadian health care facility to examine the effectiveness of the postoperative pain management strategy for children admitted to the postanesthesia care unit (PACU). Effective control of postoperative pain involves several preventive strategies that include preoperative analgesia, appropriate use of intraoperative analgesic techniques, and identification of children at risk for significant postoperative pain. Successful implementation of these techniques requires a multidisciplinary team approach involving the patient, the PACU nurses, the anesthesia care provider, and other surgical team members.

BackgroundNarrative data about the patient experience of surgery can help healthcare professionals and administrators better understand the needs of patients and their families as well as provide a foundation for improvement of procedures, processes and services. However, units often lack a methodological framework to analyse these data empirically and derive key areas for improvement. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) is aimed at improving the quality of surgical care by collecting patient data and reporting risk-adjusted surgical outcomes for each participant hospital in the programme. Though qualitative data about patient experience are captured as part of the NSQIP database, to date no framework or methodology has been proposed, or reported on, to analyse these data for the purposes of quality improvement. The goal of this study was to demonstrate the feasibility of using content analysis to empirically derive key areas for quality improvement from a sample of 3601 narrative comments about paediatric surgery from patients and families at British Columbia Children’s Hospital.Study designThematic content analysis conducted on a total of 3601 patient and family narratives received between 2011 and 2018.ResultsOverall satisfaction with care was high and experiences with healthcare providers at the hospital were positive. Areas for improvement were identified in the themes of health outcomes, communication and surgery timelines. Results informed follow-up interprofessional quality improvement initiatives.ConclusionsRecording and analysing patient experience data as part of validated quality improvement programmes such as ACS NSQIP can provide valuable and actionable information to improve quality of care.

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