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Shorter wait times and better care at the MUHC Alan Edwards Pain Management Unit

Novel triage process makes sure patients can access sub-specialists faster.

Worldwide, chronic pain affects approximately one quarter of the population—with staggering costs to the individual patient and society. These figures have been increasing with the ageing population and improved survival rates for formerly lethal conditions, such as cancer.

The novel triage process has enabled the Alan Edwards Pain Management Unit to cut the average wait time from two years in 2009 to 6 months in 2019.

In Quebec, the Centres of Expertise in Chronic Pain receive an incredibly diverse range of patient referrals with a wide variety of chronic pain conditions, some of which require rapid access to treatment. Still, the waits for a first appointment in one of these centres can be up to six years.

With the goal of improving on wait time, the Alan Edwards Pain Management Unit (AEPMU) of the McGill University Health Centre (MUHC) has developed a novel triage process.

“This began with a survey of more than 50 pain clinics worldwide to see what could be learned from them through best practices,” says Dr. Yoram Shir, director of the AEPMU. “With this knowledge and collaborative work, we have created a unique process to make sure our patients can access the right sub-specialists within an acceptable delay.”

One of the main elements of this novel triage process is the clinician-led group session for new patients, which typically take place within 2–4 weeks from the time of the referral from a physician. “Patients are provided with information on chronic pain, services offered at the Alan Edwards Pain Management Unit and resources available in the community and online,” says Dr. Shir.

The new process has enabled the Alan Edwards Pain Management Unit to cut the average wait time from two years in 2009 to 6 months today, and this in spite of a constantly rising number of consultations over the same period. This is by far the lowest wait time of any tertiary pain management unit in Quebec, and one of the lowest in Canada.

For patients, the shorter wait times have made all the difference.
“It immediately felt as though I’d found a safe place – to be a patient, a person,” says Sandra Woods, a patient of the AEPMU. “The impact of my disease wasn’t something that I’d have to struggle to communicate to another disbelieving physician. That feeling, of the AEPMU being my ‘safe place’ remains intact.”

NOVEL TRIAGE PROCESS MAIN ELEMENTS
  1. A comprehensive package of questionnaires and information is mailed to the patient once the referral is received.
  2. A clinician-led group session is set up for the new patients, within 2–4 weeks from the time of their referral.
  3. The AEPMU uses the sessions to gather information on the patient’s pain condition, set expectations and expose them to the diverse clinical research program. Patient feedback is constantly used to improve the sessions.
  4. All patient information (medical, social, environmental, and psychological) is then analyzed by a multidisciplinary triage team to determine which sub-specialists would be best suited to see the patient—high priority patients can be seen within four weeks.
  5. The referring physician is kept in the loop and may contact the AEPMU triage team should she/he feel that a shorter delay for the patient is indicated.