Abstract

PR1-155

Family empowerment beyond the perioperative period: Optimization of pain experience for children undergoing pectus and spine surgeries

¹Chidambaran V, ¹Mecoli M, ¹Brown R, ¹Sturm P, ¹Garcia V, ²Lane B, ²Rednour A, ²Vogel C, ²Spang K, ²De Ocaza Murua A
¹Cincinnati Childrens Hospital, Cincinnati, OH, United states; ²Univ of Cincinnati, Cincinnati, OH, USA

Background: Spine fusion for scoliosis and Nuss procedure for pectus are among the most painful surgeries healthy, opioid naïve adolescents undergo. Pain can extend beyond the perioperative period, and pain experience depends on family interactions and preexisting psychosocial factors.1,2 Thus, in order to optimize pain experience, focusing on perioperative pain protocols is not sufficient. We conducted a quality project in conjunction with the Livewell Collaborative (LWC) to design an optimal pain management system extending from the early preoperative stage through post-surgical recovery at home, and to create a solution system that empowers both patient and parent at all stages of this perioperative journey. The LWC applies innovative design-thinking based on collective learnings from previous projects, benchmarking and input from all stakeholders.

Methods: Two phases of this project were conducted over 10 weeks: the research phase, during which 7 semi-structured interviews across 12 stakeholders (families/children who had previously undergone spine and pectus surgeries at our institution, and multi-professional, multidisciplinary care providers) were conducted to map perioperative journeys and identify factors that provide positive and negative pain experiences for patients; and the ideation phase, during which focus groups identified tools with the greatest impact for reaching our goals.

Results: In the first phase, a common journey map with major milestones for patients undergoing both surgeries was created, starting from referral, and ending with first follow up evaluation by surgeon after home discharge. Anxiety levels from the patient’s/parent’s perspectives were mapped out as a visual tool to help understand key periods of enhanced anxiety, which were identified as timings for future interventions (Fig 1). Key positive and negative influencers of pain experiences, and potential improvement opportunities in 5 areas were identified (Fig 2). The ideation phase used a non-weighting matrix within these 5 areas to evaluate current tools. New enhanced tools targeted to 4 parent-child engagement dynamic spectrums were identified, with three system themes – empowering, road map and communications.

Conclusion: Our findings are driving the implementation of identified innovations at key periods of increased anxiety. Holistic, non-opioid strategies targeting the patient-family unit, are being emphasized through this project as a means of optimizing the perioperative pain experience.

References:
1. Rabbitts JA, et.al. Pain 2015; 156(11): 2383-9.
2. Chidambaran V, et. al. European journal of pain 2017. Aug;21(7):1252-1265