Chronic pain management is an evolving multi-specialty practice, requiring complex graduated care from primary care to specialty care. In recent years, the use of interventional pain procedures for the management of chronic pain has expanded dramatically, and health authority outpatient clinic wait lists for these procedures have been growing. As a result, there has been an increase in the provision of these services outside of the hospital setting such as in private clinics and physician offices without much guidance on the appropriate credentials, settings, techniques and equipment required for safe patient care. Complex and highly specialized procedural pain management (PPM) procedures can create significant risk to patients, and specialized training, knowledge and skills are required to perform them safely.
In 2016, recognizing these risks, as well as the need for patients to have access to safe and appropriate care, the College announced and began an initiative to develop standards for the accreditation of PPM procedures performed outside the hospital setting in community-based physician offices, practices and clinics. In parallel was the BC Medical Quality Initiative’s development of a new privileging dictionary for procedural pain management which categorizes PPM procedures, using a tiered approach, from Basic to Advanced II.
The draft accreditation standards for community-based PPM offices, practices and clinics have been developed and will soon be posted on the College website for a 90-day consultation and review period. The process for developing these standards included convening an advisory panel of subject-matter experts in pain medicine, anesthesiology (including family practice anesthesia), interventional radiology and physical medicine and rehabilitation. There has also been discussion with the Ministry of Health, including the provincial chronic pain strategy group, health authorities and front-line care providers regarding the impact of this quality and safety initiative.
The draft accreditation standards address
- the PPM procedures that may only be performed in an accredited facility,
- the requirements for imaging (ultrasound, fluoroscopy, CT),
- the requirements for infection, prevention and control, and
- the requirements for patient safety and quality care.
When the consultation is complete and the standards approved by the Non-Hospital Medical and Surgical Facilities Accreditation Program Committee, the implementation plan will allow time for physicians, offices, practices and clinics to transition intermediate and advanced PPM procedures to the appropriate setting as needed.
The College recognizes that initially there may be a perceived loss of access by patients. However, by ensuring the right provider, the right imaging and the right setting through the accreditation of PPM procedures performed in the community-based setting, the College can ensure patients will receive safe and appropriate care.
Heidi M. Oetter, MD
Registrar and CEO
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