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So many people on the pain round in the morning, yet it is very inefficient, plus multiple breaks. Then in the afternoon everyone disappears and the pain reg is left to finish the rest of the round and see the new referrals. I think that those rostered to a clinical shift should be present and active on the pain round until it's done

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As previously mentioned, there is actually a pretty well resourced pain service but the staff seem to be so poorly utilised.
The only consistent person doing work on the round is the registrar.
The reg is reliably present from 0730 to 1730 or sometimes later (unless they can hand the pager off early)... Everyone else seems to treat pain round as a bit of an optional timetable where they can come and go as they please. Very irritating.

HMO
It is SO helpful to have a resident rostered to the round (although Iknow it's dreary for them, but their roster is otherwise pretty good) and think
we could really use a reliable roster of an HMO for one session every day, either morning or afternoon. They get treated like med students so often in the anaesthetic rotation but they are capable and knowledgeable doctors who run the round in other hospitals. To have them available to split off with a nurse or consultant to see patients on a long round would be invaluable, and they are more than capable of taking and seeing referrals. Why do we treat them like students??

FELLOW
Who are they? When are they here? When are they MEANT to be here (since they seem to go home early or do paperwork etc). Very useful when they are around and doing rounds, but this seems to be a mystery....

CONSULTANTS
I would reiterate what someone else already said. Coffee and paperwork seem to be top priorities. It's nice to get advice on complex patients. It's even nicer when advice is consistent.

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Spend ages educating about pre-emptive analgesia. Do we need to do some work with the physios on this? Is inadequate analgesia contributing to less than perfect physio engagement

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Sizeable minority of relatively complex pain pts have their morning long acting opiates etc omitted because fasting, could translate to poor pain control in recovery. Then you get called about them regularly in the evening

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Need a defined role for the registrar and HMO, service provision? Learning? There is a lack of teaching I've found.

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Really annoying to have to re-write these prescriptions all the time, especially overnight. Could we have more spaces for boluses?

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FIRSTLY, Thanks Aaron for doing this!
1. Inefficiency. Starting with the start time - The job starts at 7:30.... but the day doesn't start until 9? There needs to be a definitive start time and the nursing staff need to be there at 7:30. Then on the ward rounds - 1 person does all the work yet there are often 4 or 5 people on the round chatting....  Then the coffee breaks - I'm all for coffee... but... seriously..... it's so frustrating and makes for a boring day.
2. Clarify the role of the pain nurses. Are they there to write notes? See patients? Assist with decisions? Are they present for continuity of care? at the end of each reg's week, why is there not a pain nurse on the Friday who knows all the patients?  Are they present to take referrals? Give advice? Assist with procedures? After all this time, i have NO IDEA what the job of the nurses is..... There definitely needs to be a distribution of the workload and a clarification of what is expected of the nurses, other than making sure we have a sit-down.
3. Consultant expectations. Do we expect the consultant to review patients? Teaching? do we want them to see 3 patients and then have meetings/paperwork all day? I think this needs to be clarified and consistent
4. Handover. We have SO many people on the pain round, why do we not have a handover tool that is useful? Why are we still using/printing lists with no information other than the ED presentation diagnosis? Not helpful. Slows down the rounds EVERY day trying to work out what is happening, even with patients who have been in hospital for 60+ days.....

Overall,  I think we are underutilising the HUGE resources of the pain team in comparison to the rest of the hospital. It could be so much more efficient, enjoyable, productive and with better patient care.

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The round at weekends is too big to allow me to remain fully focussed on my patients. It becomes a slog which I want to get done as fast as possible rather than an opportunity to improve patient well being.

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It takes a long time to work out the context of the pain in a patients background history, particularly with complicated patients.

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New referral system, need to collect more data other than simply ED presentation diagnosis which is often nonsense. PMHx, current pain regimen and U+E on referral...since electronic pain scores coming with paperless system need to think about how we build in audits/retrospective research now and get out in front.

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A session at intern and resident teaching early in the year about simple analgesia and escalation.

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More education of inpatient teams about referrals. Firstly: as like any other inpatient referral system it should be doctor to doctor referrals. No calls from nurses asking for pain reviews!! Also I think we should be involved in educating other teams to be able to prescribe simple multi-model analgesia. It's very frustrating getting referrals when simple analgesia has not been charted.

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Too much time is spent on the APS round trying to work out who the patient is and reason for referral. Similarly referring to APS is not always easy.
Maybe a form with a relevant/brief summary would be useful for both ends

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Really inefficient ward rounds. Poor communication and indecision. Lots of repetition in notes. No consultant overview as regs used as service provision-don't learn anything

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Better referral system. Feel like I say the same thing a million times on phone calls.

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Feedback from overnight decisions- I never know if I did the right thing. Did it actually work?

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*******I know there are quite a few things that could be changed for the better. Write your unfiltered suggestions, I'm going for quantity and repetition rather than a unified theory of everything******

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*******I know there are quite a few things that could be changed for the better. Write your unfiltered suggestions, I'm going for quantity and repetition rather than a unified theory of everything******

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Self renewing epidural/PCA forms anyone?
A button on the phone that would deliver the intern a mild electric shock for not already starting paracetamol?