Association between self-reported pain experiences in hospital and ratings of care, readmission and emergency department visits: a population-based study from New South Wales, Australia

Introduction: Evidence on patient experiences with pain in hospitals and its impact on post-discharge outcomes is limited. This study investigated the prevalence of pain in hospitals, patient characteristics associated with pain management adequacy, and the link between pain experiences, care ratings, readmission and emergency department visits after discharge.

Methods: We conducted a retrospective cross-sectional analysis of the 2019 Adult Admitted Patient Survey, focusing on self-reported pain experiences, including presence, severity and management adequacy. The outcomes included self-reported overall care ratings; readmission; and emergency department visits within one month of discharge. Multivariable logistic regression adjusted for population weight was used to estimate adjusted odds ratios.

Results: Among 75 large public hospitals, 21,900 patients responded (35% response rate), with 51% of patients reporting pain (mean (SD) age 57 (8.8) y; 54.9% female), 38.3% of whom classified their pain as severe. Aboriginal and/or Torres Strait Islander people and patients who spoke a language other than English were less likely to report adequate pain management (aOR (95%CI) 0.74 (0.58-0.96) and 0.82 (0.70-0.96), respectively). Pain also correlated with poor to very poor care ratings (aOR (95%CI) 2.05 (1.42-2.95)). Those patients who experienced pain were twice as likely to be readmitted (aOR (95%CI) 1.92 (1.55-2.37)) or visit the emergency department after discharge (aOR (95%CI) 1.91 (1.58-2.32)). Conversely, adequate pain management was associated with a lower likelihood of readmission (aOR (95%CI) 0.69 (0.51-0.94)) and emergency department visits (aOR (95%CI) 0.62 (0.44-0.87)). Mediation analysis suggests adequate pain management significantly mediated the relationship between pain severity and hospital rating (50.8%), readmission (11.6%) and emergency department visits (5.9%), after adjusting for all available observed confounders.

Discussion: This study highlights the importance of adequate pain management in patients' perception of care and recovery outcomes, especially among culturally and linguistically diverse patients.