(O-K4) Two Year Results from a New Model Pain Coach Educator Program and Integrative Discharge Toolkit for Pain Management in an Urban U.S. Teaching Hospital and Emergency Department During COVID-19 Pandemic

Objectives: To describe the two-year implementation pilot and descriptive analysis of a novel emergency department (ED) pain coach educator program including a customized integrative patient pain toolkit for use at home including patient demographics, pain characteristics, coaching and toolkit topics, implementation challenges, and one month patient feedback and toolkit utilization survey.

Background: Pain is the most common presenting ED complaint, yet most emergency professionals receive minimal education about nonpharmacologic, integrative pain management options. It is faster to administer or prescribe medications than to provide patient education and nonpharmacologic, nonopioid modalities. The US and others are dealing with opioid epidemics resulting in a renewed focus on pain education and integrative alternatives. The COVID-19 pandemic escalated pain management challenges. To address this, we developed a novel ED pain coach educator program providing individual, customized education sessions and integrative pain management toolkits for acute and chronic pain followed by a one-month feedback and utilization survey.

Methods: The project was implemented in an urban U.S safety-net, not-for-profit hospital system and registered with the affiliated university’s Quality Improvement Project Registry. Data collection occurred from January 1, 2021 to December 31, 2022 with enrollment initially starting in EDs and trauma center followed by expansion to select inpatient services. Study inclusion criteria included patients ≥ 14 years with acute or chronic pain with preference given to high risk or high utilization patients. Patients were excluded if in extreme pain prior to initial assessment and treatment, incarcerated, violent, suicidal, or critically ill. A training program and curriculum was developed for inaugural pain educators. Toolkits were customized based on type of pain and interest with a choice of 7 integrative options and 17 educational brochures. Patients were identified through Electronic Health Record (EHR) tracking systems, paging, rounding, shared service patient lists, or by healthcare professional verbal request. All data were stored and managed in REDCap. Beginning November 2021, patients completed a 30-day post-session phone survey which included questions about frequency of home toolkit use and session feedback. Descriptive statistics, Area Deprivation Index (ADI), medical and pain diagnoses, education and toolkit items provided, challenges, and follow-up survey data were collected and analyzed.

Results: There were 1492 sessions conducted over two years with 1,295 unique patients receiving pain coach education sessions and discharge toolkits. The average age was 47.8 years (SD=17.2). The majority were female (63.6%), Black (53.7%), and Non-Hispanic/Latino (96.6%). Most (43.6%) had a high level of socioeconomic disadvantage (ADI score >85, range 2-100). Sessions occurred in the ED (63.5%), in-patient (28.8%), out-patient (4.6%), and other (2.6%). Pain was reported as acute (55.3%), acute on chronic (28.1%), and chronic (16.6%), with patients often having multiple pain diagnoses (musculoskeletal, 73.4%; abdominal/pelvic pain, 13.8%; and low back pain, 12.8%). During customized educational sessions 89.7% of patients received 4 flat tires analogy stress ball, 87.9% hot/cold therapy, 86.9% aromatherapy inhaler/education, 56.6% pain journal with guided questions, 48.7%, virtual reality viewer, 33.4% therapeutic coloring, and 16.5% acupressure device. The top three challenges in conducting pain coaching sessions included medical condition such as nausea or lethargy, 14.5%; time constraints, 7.9%; or too much pain, 6.8% with 65.1% of sessions reporting no challenges. Of the 185 survey respondents, 169 remembered the session and were using toolkit items at home with 147 (86.9%) rating the session as helpful or very helpful and 135 (79.9%) using toolkit items daily or weekly. .

Conclusions: Results from this novel ED based pain coach education/toolkit program provide valuable insights and benefits for development of an international pain coach model. Most patients ranked the program as very helpful/helpful with continued use of integrative toolkit items at one month and qualitative statements of patient satisfaction and improved functionality. Appropriate timing of approach was a key issue. Multidisciplinary project champions and recognition were important to project success along with rounding. All program materials including an implementation guide are available online. Future plans include assessing program outcomes such as readmission and return ED rates, decrease in opioids, cost-effectiveness, and functionality.

References (Optional): 1. https://pami.emergency.med.jax.ufl.edu/
2. Sheikh S, Schmitzberger M, Jenkins C, Mitchell N, Suffield D, Norse A, Fishe JN, Webb K, Kiel J, Eraso D, Parnes JG, Hendry PL. Pain Assessment and Management Initiative's Emergency Department Alternatives to Opioids Program Over- the- Counter Starter Pack Initiative and 30-Day Emergency Department Pain-Related Revisits. Academic Emergency Medicine SAEM22 Abstracts S56-7. https://dx.doi.org/10.1111/acem .14511
3. Sheikh S, Schmitzberger M, Liao R, Brailsford J, Fishe J, Norse A, Webb K, Spindle N, Suffield D, Hendry P, on behalf of the PAMI ED-ALT Group. Preliminary Results of PAMI-ED ALT: An Emergency Department Opioid-Alternatives Program. Supplement to Annals of Emergency Medicine 2021;78(4S):109. https://www.annemergmed.com/article/S0196-0644(21)01076-3/pdf
4.Hendry P, Suffield D, Sheikh S, Spindle N, Schmitzberger M, Velasquez E, Lott M, Fishe J, Johnson B, Kendall Webb L, Norse A. Preliminary Results From An Emergency Department Pain Coach Service And Discharge Toolkit Pilot Project During COVID-19. Supplement to Annals of Emergency Medicine 2021;78(4S):s86. https://doi.org/10.1016/j.annemergmed.2021.09.226

Funding (Optional): This work was funded by the following grants and organizations: University of Florida College of Medicine — Jacksonville Department of Emergency Medicine, Florida Medical Malpractice Joint Underwriting Association Alvin E. Smith Safety of Health Care Services Grant Program, Substance Abuse and Mental Health Services Administration Emergency Department Alternatives to Opioids Demonstration Program (SAMHSA ED-ALT -grant number H79TI083101), Overdose Data to Action (OD2A). OD2A is a grant-based program with 100% of its funding from the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS). The content of all materials, programs, and presentations are those of the authors and investigators and do not necessarily represent the official views of, nor an endorsement, by FMMJUA, CDC, HHS, or the U.S. Government.