The Impact of Assessment and Reassessment Documentation on the Trajectory of Postoperative Pain Severity: A Pilot Study

Comparing organizational approaches to pain management is warranted to understand best practices and provide decision makers with evidence on which to base resource intensive documentation policy decisions. To provide this evidence, a multilevel modeling (MLM) approach is required to accommodate the interrelatedness and nested nature of pain management factors affecting outcomes. Along with MLM, the widespread adoption of the electronic record provides an ability to capitalize on the repeated measurement benefit of the current pain management documentation output by using pain severity trajectory (PST) as a precise and clinically relevant outcome of interest. Therefore, the purpose of this pilot study was to examine the methodological issues that arise when conducting MLM research aimed to answer the question: what is the impact of assessment and reassessment documentation routines on postoperative pain severity trajectory? Researchers used timed pain management documentation data output to construct a growth model of a patient’s PST and performed a two-level analysis from a convenience sample of 3 hospitals and 146 patients. Analyses revealed that the hospital where care occurred, the type of surgical procedure, and the presence of reassessment documentation within one hour of intervention affected the PST. Pilot work showed that pain management documentation output could be reformulated into research variables for hypothesis testing. The presentation of the reassessment data output posed a measurement limitation. An interdisciplinary research team is needed to adequately compare organizational practices. Basing policies on evidence has the potential to improve pain management care.