Rapid triage evaluation: one initiative solves three pain clinic performance imperatives

Abstract

Multidisciplinary pain clinics face a growing number of challenges: Access to multidisciplinary pain care can take months. Opioid management has become increasingly complex as standards change and the risks of chronic opioid therapy are headlined. Co-occurring psychiatric conditions and substance use disorders can be barriers to successful treatment within a multidisciplinary framework. Reimbursement for multidisciplinary treatment is declining. Fairview Pain Management Center provides multidisciplinary pain management to over forty affiliated primary care clinics. We were faced with three imperatives: 1. Reduce the wait times for pain evaluations to less than two weeks and provide timely help and guidance to the referring primary care physician. 2. Enhance the screening of patients to assure that those we do treat are likely to participate fully and have successful outcomes, while avoiding enrollment of patients for whom multidisciplinary care is unlikely to be effective or practical. 3. Increase patient volumes (i.e. revenue) to meet the expectations of a health system that is facing budgetary challenges. The Rapid Triage Evaluation (RTE) was developed to address these challenges. Patients are scheduled within two weeks for a RTE without our customary preliminary screening. The RTE is a 20-30 min evaluation carried out by the pain specialist in order to get a quick assessment of the nature of the pain problem, suitability for multidisciplinary pain treatment, appropriateness of opioid therapy, and to identify other interventions that a primary physician can initiate without delay. No prescriptions are written and no procedures are carried out during the RTE. Comparing outcomes before and after instituting RTE, we demonstrate reductions in wait times, higher engagement among patients entering multidisciplinary care with fewer missed appointments, higher volumes, and increased satisfaction among referring physicians who are given immediate treatment recommendations and practical advice about opioids.