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If you wish to respond to a paper or other item already published in the BJA, please go to the abstract/full text version of that item and click on the link "E-Letters: Submit a response to the article".

Electronic Letters to:

Pain:
A. E. Powell, H. T. O. Davies, J. Bannister, and W. A. Macrae
Challenge of improving postoperative pain management: case studies of three acute pain services in the UK National Health Service
Br. J. Anaesth. 2009; 102: 824-831 [Abstract] [Full text] [PDF]
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Electronic letters published:

[Read E-letter] Hospital-wide Pain Surveillance
Gary B Smith, David Prytherch, Peter Featherstone and Paul Schmidt   (23 June 2009)

Hospital-wide Pain Surveillance 23 June 2009
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Gary B Smith ,
David Prytherch, Peter Featherstone and Paul Schmidt

Send letter to journal:
Re: Hospital-wide Pain Surveillance

We would like to congratulate Powell et al. on their excellent, if disturbing, paper on postoperative pain relief in the UK National Health Service (Powell et al. BJA 2009; 102:824-831). There are obvious parallels with the system failings that have been reported in the context of failure to recognise, or respond to, patient deterioration.1-3

We feel that an essential part of the solution to these complex interrelated system-wide problems is for hospitals to use patient-centric data to care for the patient, and to enable proper management and clinical governance of the service. Such data collection inevitably requires the use of technology, which needs to be acceptable to front-line clinical staff, should be part of routine clinical practice, universally deployed and integrated with the hospital IT infrastructure.

Our hospital (Portsmouth Hospitals NHS Trust) has collaborated in the development of a system with a commercial company (The Learning Clinic, London) for the hospital-wide surveillance of patients’ vital signs, early warning scores (EWS) and other clinical data, e.g., pain scores.4 These data are collected routinely at the bedside using standard personal digital assistants (PDA) and transmitted automatically using the hospital intranet to PC tablets in clinical areas and to all other hospital PCs. Any member of staff with the appropriate access rights can view the full list of patients being monitored by the system, their past and current vital signs, and their pain and sedation scores at all times. The list of patients can be ordered by EWS, pain or sedation score, providing visibility of those with high scores and allowing ward staff and other teams, (e.g., outreach, acute pain) to prioritise their clinical input. The organization benefits because the system, VitalPAC, permits the data to be broken down by specialty, consultant, ward, etc, to facilitate appropriate clinical governance. In due course, it will be possible to “push” pain scores and information regarding analgesia directly to the appropriate staff (e.g., acute pain team) via mobile communication devices.

Whilst Powell et al’s findings arise exclusively from the postoperative period; our solution is hospital-wide and includes the collection of pain scores in acute medicine. We are currently completing the hospital-wide deployment of VitalPAC and learning how to use the data it provides for the management of individual patients and the hospital as a whole. We believe that this approach will solve many of the problems outlined by Powell et al.

References

1. National Confidential Enquiry into Patient Outcomes and Death. ‘‘An acute problem?’’ London: National Confidential Enquiry into Patient Outcome and Death; 2005.

2. National Institute for Health and Clinical Excellence. Acutely ill patients in hospital: recognition of and response to acute illness in adults in hospital. London, 2007. (NICE clinical guideline No 50.)

3. National Patient Safety Agency. Safer care for the acutely ill patient: learning from serious incidents. NPSA, London, 2007.

4. Smith GB, Prytherch D.R, Schmidt P, et al. Hospital-Wide Physiological Surveillance: A new approach to the early identification and management of the sick patient. Resuscitation 2006; 71: 19-28.

Conflict of Interest:

The electronic vital signs data gathering system described here, VitalPACTM, is a collaborative development of The Learning Clinic Ltd and Portsmouth Hospitals NHS Trust. Professor Gary Smith’s wife and Dr David Prytherch’s wife are shareholders of The Learning Clinic Ltd. Dr Schmidt has a directorship in a UK registered company, Proxximity Systems Ltd, which holds a minority shareholding in The Learning Clinic. Dr Peter Featherstone has no conflicts of interest.