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Anesthesiology

Introduction to CPS

Comprehensive Pain Service (CPS)

Mission:

The mission of the Vanderbilt University Division of Pain Medicine and the Comprehensive Pain Service is to provide exemplary leadership in the treatment of acute and chronic pain through: 1) evidence-based and innovative patient care resulting in continually improving patient outcomes, 2) revered physician education and training, and 3) clinical and scientific discovery that will transform the future of pain medicine

We practice as an integrated care team of physicians and allied health specialists under physician guidance.

Our goal is to focus on the need of the patients, providing the best pain treatment possible, including procedures for perioperative services such as epidural procedures and nerve blocks, injections and catheter infusions, as well as any necessary interventions for trauma consults, medical, surgical, oncologic, or palliative consults, oral and parental medications, implantable devices as well as non-pharmacologic methods of pain management.

We strive to provide education for other physicians and allied health personnel as well as incorporate research programs to improve patient care at Vanderbilt University.

Work Responsibilities:

CPS NP: 

Carries pager 207-1203, Monday- Friday 08:00-23:00

Rounds on all routine epidural catheter and nerve block/perineural catheter patients in AM, along with rest of CPS team. Performs teaching and troubleshooting of catheter or pump related problems after rounds. Maintains census on Star Panel of all acute and chronic consult patients that are actively receiving care or have been consulted on and the service is still following.

Discusses problems, specific issues with CPS consultant.  Performs initial assessment of new post-op catheter patients including brief note. In cases where the patients pain is not adequately controlled in the PACU, the CPS resident will be called to assess ad possibly consider either other adjuvants or repeat block.

 

CPS Resident:

Senior resident carries pager 207-1198, Monday- Friday 10:00-20:00

Junior resident carries pager 207-1201, Monday- Friday 10:00-20:00

Rounds with CPS team on routine epidural/perineural catheter patients in AM after arrival

Assists with acute on chronic and chronic pain consults, including non-routine catheters.

Receives consult requests and coordinates patients’ evaluation in accordance with needs and within consult guidelines of service.

Assists Pain RN as needed and provides oversight during afternoon and early evening rounds. Signs out with home-call resident prior to departing at 20:00. Junior resident assists perioperative regional anesthesia after 17:00 when regional senior resident leaves for the day.

 

CPS Pain Fellow:

Responsible for management of Comprehensive Pain Service with assistance from the consultant. Generally assists with AM blocks and as needed throughout the day. Assists with placement of any scheduled operative devices if Chronic Pain fellow. Provides leadership for rounds, patient consults and inter-service relations.

 

Regional Fellow:

Carries pager 207-1197

When on service as CPS fellow, responsible for coordinating perioperative regional anesthetics/analgesic procedures and trauma related consults. Participates in fellows call pool. Rounds on some weekend days, and participates in teaching of residents and allied health personnel.

 

CPS Consultant: 

Carries pager 207-1193, Monday-Thursday and Friday-Sunday 6:30-17:00 or at time set for weekends and evenings.

Assists Regional Attending I and II with first case starts of patients requiring nerve blocks, epidurals, or nerve catheter placements after appropriate consultation with CPS. Leads the morning rounds with resident, fellow(s) and Pain RN on routine catheter patients in AM. Rounds with CNP/PA, residents and fellow for new consults, subsequent daily visits, and non-routine catheter patients.

Remains available for Acute Pain RNCNP/PA, resident, and fellow supervision throughout day.

Assists resident and fellow with procedures especially first starts of day, or as necessary during the day depending on regional attending availability.

 

Regional Consultant:

Carries phone 456-8038 Monday-Fri 06:30 to 17:00

Assist resident and fellow with perioperative regional anesthesia procedures

 

Coverage:

The service is covered 24 hours/day, 7 days a week. The home call resident covers the service 20:00-06:30.  The call consultant and CPS Fellow are available for consultation as needed. Weekend rounds will be performed by the CPS Consultant, CPS Fellow, and residents as worked out by the residents making up the service for that given time period.  Generally, the Consultant rounds with the fellow and intern on Saturdays, and the resident on Sundays.

 

Consults:

Consults received weekdays between 08:00-13:00 are seen the same day by resident/fellow and staffed within 24 hours. Off-hour and weekend requests are seen by the rounding team or by the R1 if available. Phone triage allows patients with symptoms benefiting most from expedient intervention as well as giving assistance to the requesting service in implementing adequate pain control according to CPS algorithms. For cases where more urgent consult requests need to be addressed, the home call resident will receive notification, and they will call the R-1 resident for an urgent bedside visit. If the R-1 is too busy, the fellow on call will be notified and will need to assess the situation. If patients’ condition warrants an early or immediate intervention, e.g. a new trauma consult with multiple fractured ribs and flail chest with worsening pulmonary toilet, then the fellow will call the attending to come and assist with thoracic epidural catheter placement. Emergency situations need to be handled according to available and existing pathways such as RRT or Codes. The CPS does not have the availability to do emergent consults.

Prerequisites for obtaining a formal pain consult include assessment by primary service, phone request, and patient availability the day of consult. If discharge plans have already been made for the patient for the following 24 hours, the patient may, at the CPS consultant’s discretion, be scheduled on the next available consult opening in the Pain Clinic per scheduling through our office manager, Amy Turner at 875-6203 or amy.turner@vanderbilt.com  A total of 4 patient appointment slots will be kept open for this possibility each weekday. These appointments will be in the Persistent Pain Clinic, which is designed to enable ongoing outpatient care for some post-surgical or medical conditions.

 

Catheters:

The CPS is notified by the consultant/ resident who has placed the catheter before the patient leaves the OR/PACU if coverage is desired. The catheter will be in working order, tested if indicated, and a continuous infusion of pain medications started in the PACU. If the catheter is found not to be functioning, it must either be discontinued with other means of pain control instituted, or replaced in the PACU. Epidural catheters routinely have a PCEA mode ordered and may rarely be programmed with local anesthetic only with concomitant oral or parenteral opioids, including PCA. Brachial plexus or femoral/popliteal catheters may have narcotic PCA ordered (if the patient is voluntarily able to push the appropriate button) before leaving the PACU or may receive orders for either oral, parenteral or PCA analgesics.

All epidural or perineural catheters should follow CPS guidelines. If the placing anesthesia consultant warrants that another protocol would better meet the patient’s needs, prior discussion with the CPS consultant will be required for this accommodation to be made by CPS.

Exclusions:

Due to large patient volumes, the CPS is not able to provide coverage for pre-/ postop visits, conscious sedation, or OR break coverage. Anesthesia related complications such as post -procedural neuropraxias, catheter related infections, or other situations in which the expertise of the CPS is most applicable to the clinical situation should be arranged via consultation with the CPS attending. This does not mean that the involved attending and staff should relinquish involvement. The CPS will make every effort to help our colleagues with necessary consultations, orders, and arrange outpatient follow up for these uncommon situations.

This page was last updated February 13, 2013 and is maintained by