Making Pain Care a Priority; New Standards Take the Hurt out of Healing at Virginia Mason Medical Center

Article excerpt

Byline: Jennifer Barrett

Last summer, when Jack Stuckrath learned that he needed surgery to remove part of his esophagus, the Seattle store owner tried not to worry about the pain that would surely follow. It seemed a small price to pay for the promise of good health. A few weeks earlier, Stuckrath had been diagnosed with esophageal cancer, a rare and often fatal disease. "I was just delighted it was operable," says the 62-year-old father of six.

So he was pleasantly surprised when he woke up at Virginia Mason Medical Center after the surgery, which required incisions across his chest and abdomen, and felt no discomfort at all. Within hours Stuckrath was able to stand up and even take a few steps. Six days later he was discharged. "It was pretty miraculous," he says. "Not having pain made all the difference."

There's no question that managing pain plays a central role in a patient's recovery, but at many hospitals, it has often seemed an afterthought rather than a priority. That's starting to change. In January 2001, the Joint Commission on Accreditation of Healthcare Organizations implemented its first pain-management guidelines, requiring the country's more than 4,400 accredited hospitals to make sure that all patients are evaluated (using a now standard scale of zero to 10) and treated for pain.

That was a critical first step, but some hospitals, like Virginia Mason, have gone much further. A few years ago CEO Gary Kaplan adopted Toyota Motor Co.'s "lean manufacturing" model--which focuses on decreasing errors and increasing productivity and customer satisfaction--and encouraged his 5,000 staff members to submit suggestions. That led to innovations in several areas, including pain management.

Patients like Stuckrath are the beneficiaries. He got a thoracic epidural that delivered both a narcotic and a local anesthetic, a technique shown to help patients wake up faster and in less pain. A "pain-service team"--a doctor, nurse specialist, pain fellow and resident anesthesiologist--checked on him twice a day as he recovered, and a nurse came by every two hours to record his pain scores on an electronic chart and make medication adjustments. …