Becker's Spine Review

Pain Management 44 eed says. Many primary care physicians may hesitate to write prescriptions for opioid narcotics because of potential side effects and look to pain specialists for both their experience and advice. It's best when both physicians are open as to the end goal of the patient because any existing concerns or muddled communication can cause further delay in care. "When managing opioids, there is a huge advantage to communicating," he says. "If communication is not [properly] utilized, it can lead to over or under utilization." Dr. Sayeed weighs in on five challenges and solutions to keeping lines of communication open between pain management and primary care physicians. 1. Increase visibility. Working with primary care physicians begins with establishing a positive working relationship. Many times the two types of physicians won't naturally come in contact with one another frequently. Try increasing your visibility at the hospital or practice, Dr. Sayeed says. "Visibility communicates that your services are available," he says. Increasing visibility can even be simple steps, such as eating lunch at the hospital once a week or volunteering for a committee. It also increases face recognition and develops communication channels which did not exist prior. "It may not be direct communicating," he says, "but it promotes communication and builds trust." 2. Talk on the phone. The "gold standard" for communication is physicians calling one another, Dr. Sayeed says. It's the optimal way to keep both parties informed, but it is often overlooked because phone calls can be time consuming.   Direct communication can also be a form of positive marketing. "When a physician takes time to call the primary care physician, that primary care doctor will remember it," he says. "This helps build a practice. You will be known as a caring and communicative physician." 3. Use written requests. Another way for pain management physicians to keep in touch with the primary care physician is by sending written requests. Letters have been used for many years and are reliable and good for documenting the communication. However many times primary care physicians are too busy to read all of their letters. Requests can slip through the cracks or be left unattended for a period of time. 4. Send records electronically. Electronic communication, such as email, is becoming more HIPAA compliant and is the fastest means of reaching out to another physician. However, patient security still remains a large deterrent from communicating electronically, Dr. Sayeed says. Many electronic processes are not yet approved for medical use. "We have to be very careful with instant messaging, email and these types of e-media unless it's through a secure portal," he says. 5. Work toward a common goal. Pain and primary care physicians should establish a "team plan" and work together to reach a common goal of patient treatment, Dr. Sayeed says. A common goal lets the patient know there is no discrepancy of care and nothing will slip through the cracks. "Having a common care plan can be reassuring to a patient," he says. "The majority are very appreciative to have doctors communicating with each other." Developing a team plan entails brainstorming with the primary care physician and exchanging ideas and advice. "Primary care doctors tend to have a longstanding relationship with patients," Dr. Sayeed says. "They can provide information not easily gleaned from a record or chart." n 8 Benchmarks for Low Back Pain Injections in ASCs By Laura Miller T he AAAHC Institute for Quality Improvement has released new benchmarking data on four common outpatient procedures: cataract surgery, colonoscopy, knee arthroscopy and low back injection for pain management. The reports include data such as pre-operative techniques, complications, non-routine procedures, anesthesia, wrong-site surgery prevention and patient outcomes. The data also include information about staff and supply costs. The studies were performed from January to June 2012. Pain ManagementLow Back Injection (25 organizations submitted information on 488 cases) 1. Pre-procedure times ranged from 16 to 102 minutes (median 53 minutes). 2. Discharge time ranged from 9 to 48 minutes (median 25 minutes). 3. Total facility time ranged from 49 to 166 minutes (median 92 minutes). 4. 93 percent of surveyed patients indicated they were able to schedule their procedures within a reasonable period of time. 5. 99 percent said they had an adequate understanding of the procedure. 6. 82 percent reported that they were performing their usual daily activities. 7. 77 percent indicated that their pain had improved.   8. 46 percent had reduced their pain medications. n

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