Skip to main content Accessibility help

Benchmarking as a tool of continuous quality improvement in postoperative pain management

  • W. Meissner (a1), K. Ullrich (a1) and S. Zwacka (a2)



Background and objective: Quality of acute pain management is far from being satisfactory. These deficits are not caused by the complexity of the medical problem but by difficulties in organization and hospital structures, sand procedures. Continuous quality improvement is a recommended tool to overcome such difficulties and to increase quality in the long run. This study reports the implementation of benchmarking-based continuous quality improvement to improve postoperative pain management at a university hospital. Methods: A specialised pain nurse interviewed patients of three surgical departments on the first day after surgery, and continuously assessed process and outcome quality parameters. A multidisciplinary team of anaesthetists, surgeons, nurses and pharmacists implemented a regular procedure of data analysing and internal benchmarking. Results and suggested improvements were fed back to the healthcare teams. Results: From 1998 to 2002, 6756 patients were assessed. Average pain on ambulation and maximal pain were 3.7 ± 2.4 and 5.0 ± 2.5 (mean ± SD) on a 11-point numeric rating scale. Pain intensity at rest was 1.9 ± 1.8. Over time, pain intensity on ambulation decreased (P = 0.022) whereas maximal pain and pain at rest remained unchanged. There was an increase in the number of patients who received non-opioid analgesia (P < 0.001). Conclusions: A continuous quality improvement process could be established and is now successfully used in clinical routine. Cornerstones of this project were frequent assessments of process and outcome parameters, regular benchmarking and implementation of feedback mechanisms. Changes in organization of medical management and multidisciplinary teamwork seem to be more important than medical or technical aspects.


Corresponding author

Correspondence to: Winfried Meissner, Department of Anaesthesiology and Intensive Care, Friedrich-Schiller-University Jena, Erlanger Allee 101, D-07740 Jena, Germany. E-mail:; Tel: +36 41 9323353; Fax: +36 41 9323152


Hide All


Kehlet H. Effect of postoperative pain treatment on outcome–current status and future strategies. Langenbecks Arch Surg 2004; 389: 244249.
Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg 2003; 97: 534540, table of contents.
Rawal N. Acute pain services revisited– good from far, far from good? Reg Anesth Pain Med 2002; 27: 117121.
Dolin SJ, Cashman JN, Bland JM. Effectiveness of acute postoperative pain management: I. Evidence from published data. Br J Anaesth 2002; 89: 409423.
Rawal N, Berggren L. Organization of acute pain services: a low-cost model. Pain 1994; 57: 117123.
American Pain Society Quality of Care Committee. Quality improvement guidelines for the treatment of acute pain and cancer pain. JAMA 1995; 274: 18741880.
Lack JA, White LA, Thoms GM, Rollin AM. Raising the Standard: The Royal College of Anaesthetists, 2000.
Allcock N. The use of different research methodologies to evaluate the effectiveness of programmes to improve the care of patients in postoperative pain. J Adv Nurs 1996; 23: 3238.
Meissner W, Ullrich K, Zwacka S, Schreiber T, Reinhart K. [Quality management in postoperative pain therapy.] Anaesthesist 2001; 50: 661670.
Rawal N, Allvin R. Acute pain services in Europe: a 17-nation survey of 105 hospitals. The EuroPain Acute Pain Working Party. Eur J Anaesthesiol 1998; 15: 354363.
Coleman SA, Booker-Milburn J. Audit of postoperative pain control. Influence of a dedicated acute pain nurse. Anaesthesia 1996; 51: 10931096.
Tighe SQ, Bie JA, Nelson RA, Skues MA. The acute pain service: effective or expensive care? Anaesthesia 1998; 53: 397403.
Bardiau FM, Taviaux NF, Albert A, Boogaerts JG, Stadler M. An intervention study to enhance postoperative pain management. Anesth Analg 2003; 96: 179185.
McNeill JA, Sherwood GD, Starck PL, Thompson CJ. Assessing clinical outcomes: patient satisfaction with pain management. J Pain Symptom Manage 1998; 16: 2940.
Miaskowski C, Nichols R, Brody R, Synold T. Assessment of patient satisfaction utilizing the American Pain Society's Quality Assurance Standards on acute and cancer-related pain. J Pain Symptom Manage 1994; 9: 511.
Shayer M. Problems and issues in intervention studies. In: Demetriou A, Shayer M, Efklides A (eds). Neo-Piagetian Theories of Cognitive Development: Implications and Applications for Education. London: Routledge, 1992: 107121.
Davis DA, Thomson MA, Oxman AD, Haynes RB. Changing physician performance. A systematic review of the effect of continuing medical education strategies. JAMA 1995; 274: 700705.
Deming WE. Out of the Crisis. Cambridge, MA: MIT Press, 1986.
Ward S, Donovan M, Max MB. A survey of the nature and perceived impact of quality improvement activities in pain management. J Pain Symptom Manage 1998; 15: 365373.
Aubrun F, Paqueron X, Langeron O, Coriat P, Riou B. What pain scales do nurses use in the postanaesthesia care unit? Eur J Anaesthesiol 2003; 20: 745749.
Jensen MP, Chen C, Brugger AM. Postsurgical pain outcome assessment. Pain 2002; 99: 101109.
Crowley B, Lubesnick K, Sylwestrak ML. Clinical indicators: a tool for improving pain management documentation. J Nurs Care Qual 1991; 6: 4046.
Dietrick-Gallagher M, Polomano R, Carrick L. Pain as a quality management initiative. J Nurs Care Qual 1994; 9: 3042.
Gould TH, Crosby DL, Harmer M et al. Policy for controlling pain after surgery: effect of sequential changes in management. BMJ 1992; 305: 11871193.
Gordon DB, Pellino TA, Miaskowski C et al. A 10-year review of quality improvement monitoring in pain management: recommendations for standardized outcome measures. Pain Manag Nurs 2002; 3: 116130.
Joint Commission on Accreditation of Healthcare Organizations. Improving the Quality of Pain Management through Measurement and Action. Oakbrook Terrace, IL: JCAHO, 2003.


Related content

Powered by UNSILO

Benchmarking as a tool of continuous quality improvement in postoperative pain management

  • W. Meissner (a1), K. Ullrich (a1) and S. Zwacka (a2)


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.