The Division of Pain Medicine is responsible for caring for inpatients and outpatients with complaints of acute, chronic, and cancer-related pains at the University of Illinois at Chicago and Jesse Brown VA Hospitals. All modalities and interventions are used to maximize pain relief while minimizing risks. Anesthesia residents will spend two months during their training learning medication alternatives, techniques, and interventions for optimal patient care. Every attempt is made to coordinate the educational experiences between both sites; the attendings speak to each other on a daily or almost daily basis. This allows for coordination of topics, journal club, and morbidity and mortality conferences throughout the rotation. At University of Illinois at Chicago, approximately 3,200 outpatient encounters, 800 procedures, 850 consults, and 1,200 inpatient interactions are logged each year. At the VA, the numbers are approximately 3,600 outpatient encounters, 800 procedures, 900 consults, and 150 inpatient interactions per year.
At the University of Illinois at Chicago and the JBVA, the two schedules are quite similar. For University of Illinois at Chicago, the schedule is:
6:30 am, Anesthesia Conference attendance by members of the team.
7:00 am, Pain Conference attended by all who are assigned to the site. This conference is essential to educate CA-2s, medical students, and all of the rotators who join us each day. The Pain Medicine section employs six on-line sources and current Journal Articles to cover each of the 45 divisions of Pain Education as delineated by the IASP(International Association for the Study of Pain.)
Core Curriculum for Professional Education in Pain, 3rd Edition - IASP
The 5 Minute Pain Management Consult
(Sibell; David M.; Kirsch; Jeffrey R., 1st ed.)
Massachusetts General Hospital Handbook of Pain Management
(Ballantyne; Jane C.; Fields; Howard L., 3rd ed.)
Neurology for the Non-Neurologist
(Weiner, William J; Goetz, Christopher G, 5th ed.)
Pain in Infants, Children, and Adolescents
(Schechter; Neil L.; Berde; Charles B.; Yaster; Myron, 2nd ed.)
Atlas of Image-Guided Intervention in Regional Anesthesia and Pain Medicine
(Rathmell, James P. , 1st ed.)
8:00 am, Discussion of each page that was received by the on-call resident / fellow the previous night. We will focus on the specific incident with an eye towards detecting patterns of calls and areas for improvement in the service. A list is kept of each page to the respective pain pager, the time it was placed, the person placing it, the patient it concerns, and the intervention made. This is then followed by hospital rounds on all inpatients who are receiving a pain relieving modality, new consults, and patient follow up
9:00 am, Pain Clinic patients and procedures in the outpatient area. Scheduling allows the service to maintain a good pace and finish work by 3:30. This is key since all notes and billing sheets need to be submitted the day of service. Additionally, all consult notes need to be “attested” by the attending within 48 hours of their entry into the computer system. This rule mandates that the fellows and attendings check the consult list each weekend day.
4:00 pm Inpatient rounds with one of the CA-2s, a Fellow, and the Attending of the day. This will give the Attending a chance to see the problem patients, all of those receiving infusions, and all new consults. This assures compliance when bills are submitted, increases the group’s cohesiveness, and generates patient based issues for the morning conference.
Evenings / nights / weekends: The CA-2 who is carrying the pager (with the day’s fellow and attending) is available for all pages. This entails not only responding to the pages and giving advice, but also coming back into the hospital to troubleshoot problem catheters, and reassure concerned patients. The service will be very aware of the 10 hour work-rule and make sure that each resident is in full compliance. A plan will be in place to remove and then replace catheters that stop providing pain relief in the night or to provide IV opioids to bridge with analgesia until the following morning. The less that is left to chance, the better the care that is delivered to the patients.
6:30 am….the sequence begins anew with conferences, discussions, and our looking into all of the calls and events of the previous night and seeing all of the consults that were entered into the computer after the clinic closed for the day.
University of Illinois at Chicago resources:
Drs. Laurito, Votta-Velis, Rakic, Chiang
Two fellows, two residents, occasional medical students and PharmDs, rotators from other services (PM&R, Psych, IM)
Drs. Angelov, Hussain, Votta-Velis
David Cosio, PhD
Two fellows, one CA-2, occasional rotators from other services