SHM Converge Scientific Abstract ePoster Gallery-Patients on Long-Term Opioid Therapy With Acute-on-Chronic Pain: A National Study of Hospitalist Perspectives

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This national qualitative study examined hospitalist experiences caring for medically and psychosocially complex patients on long-term opioid therapy who are hospitalized with acute-on-chronic pain. The problem is common and difficult: these patients are frequently hospitalized, pain improvement in the hospital is often limited, and hospitalists must balance pain relief with patient safety.<br /><br />The study was conducted through the Hospital Medicine Reengineering Network (HOMERuN), with 30 participants from across the United States. Methods included REDCap baseline surveys, eight concurrent Zoom focus groups, and discussion questions based on the National Academy of Medicine’s “3Cs” framework for pain and unhealthy substance use. The analysis used rapid qualitative methods and thematic analysis.<br /><br />Preliminary findings showed several major challenges. Hospitalists described a heavy emotional and cognitive burden, including extensive chart review, time needed to build rapport, and difficulty setting boundaries. They also reported variability in consultant input, with some consultants reluctant to see patients, signing off early, or providing nonspecific recommendations. Care was further complicated by inconsistent practices across teams and institutions, and by siloed systems that make transitions between inpatient and outpatient care difficult. Hospitalists often end up making key decisions themselves, including medication choices, dosing, discharge readiness, and outpatient follow-up plans.<br /><br />Participants suggested that current care relies too much on individual champions rather than system-level solutions. The study concluded that hospital providers need more support in caring for patients with acute-on-chronic pain, and that evidence-based guidelines, multidisciplinary approaches, and stronger inpatient-outpatient collaboration are urgently needed.<br /><br />Next steps include identifying priority areas for clinician education, developing best practices for Acute Care Plans, establishing national inpatient pain management guidelines, and improving care transitions.

Asset Subtitle

Morgan C. Esperance

Meta Tag

Author List Amanda K. Ramsdell, Katherine Welter, Keri T. Holmes-Maybank, Morgan C. Esperance, Rebecca C. Jaffe

Category Research

Concept Acute-on-Chronic Pain

Concept Inpatient Pain Management

Concept Chronic Pain

Concept Opioid Therapy

Concept Hospitalist Role

Distinguished Non-Finalist

Presenter Organization Brigham and Women's Hospital

Presenting Author Morgan C. Esperance

Track Quality Improvement

Keywords

hospitalist experiences

long-term opioid therapy

acute-on-chronic pain

medically complex patients

psychosocial complexity

qualitative study

inpatient pain management

care transitions

multidisciplinary approaches

national guidelines

Acute-on-Chronic Pain

Inpatient Pain Management

Chronic Pain

Opioid Therapy

Hospitalist Role