Metrics details is highly important for patients after total knee arthroplasty (TKA) Problems are not only caused by medical issues but by organization and hospital structure The present study shows how the quality of pain management can be increased by implementing a standardized pain concept and simple All patients included into the study had undergone total knee arthroplasty Outcome parameters were analyzed by means of a questionnaire on the first postoperative day A multidisciplinary team implemented a regular procedure of data analyzes and external benchmarking by participating in a nationwide quality improvement project our hospital ranked 16th in terms of activity-related pain and 9th in patient satisfaction among 47 anonymized hospitals participating in the benchmarking project we had improved to 1st activity-related pain and to 2nd in patient satisfaction Although benchmarking started and finished with the same standardized pain management concept interdisciplinary teamwork and benchmarking with direct feedback mechanisms are also very important for decreasing postoperative pain and for increasing patient satisfaction after TKA Our hypothesis was that pain management can also be improved by continuous benchmarking and implementation of a pain management concept including feedback from and to educated staff Such improvements subsequently reduce postoperative pain and improve patient satisfaction Our specific pain management concept was agreed on by an interdisciplinary pain council Although postoperative pain is multifactorial this study was not aimed at discussing the concept itself but at finding out whether the manner in which the concept is implemented by the medical team may make a difference Patients older than 18 years who had received primary TKA and were able to communicate were included Exclusion criteria were: (1) patients not present at the ward at the time of data collection; (2) patients who had visitors at the time of data collection; (3) patients who refused to participate in the study; (4) patients who were sedated or asleep or had cognitive dysfunction and postoperative variables were collected from the medical records on postoperative day 1 A specialized pain nurse visited a random sample of patients on the first postoperative day Wards to be visited were randomized daily to prevent selection bias The nurse interviewed and documented postoperative pain treatment as well analgesia-related complications To avoid any interviewer-patient interaction bias the nurse informed the patients that she was working independently from the healthcare team that all information or judgements given in the interview would be treated confidentially The primary endpoint of the study was a change in NRS for pain and satisfaction The project was approved by the Ethics Committee as well as the Data Security Board of the Jena University Hospital as well as by the Ethics Committee of the University of Regensburg The study is registered in the German Register of Clinical Studies (DRKS) under the number DRKS00006153 (WHO register) The study was carried out in accordance with the ethical standards of the Declaration of Helsinki of 1975 Patients were informed in written form as well as orally by the study personnel An informed consent was obtained from all subjects Our standard pain management concept for patients undergoing TKA was used for each patient in this study patients receive oral benzodiazepine premedication followed by ischiadic nerve and psoas compartment blockage with 20 ml of ropivacaine 0.75% and 20 ml of prilocaine 1.0% for each block Patients are sedated with propofol during surgery the nurse in the intermediate care unit administers 3 mg of piritramid on demand in intervals 0.375% of ropivacaine set at 6–10 ml/h is used for nerve blockage and Ibuprofen 600 (3×) as standard analgesic on a regular daily basis oral controlled analgesia (OCA) is administered patients may get additional analgesics if required: Tramadol 100 mg (40gtt) with the possibility of a repeated dose after 30 min if NRS 3–6 and oxycodone 20 mg and a repeated dose after 1 h if NRS 7–10 In the case of persisting or increasing pain patients are advised on how to avoid pain by self-activation and are asked to report any occurrence of pain as well as its characteristics Cool packs for the affected knee are also provided and nurses implemented a regular procedure of data analyzing and internal benchmarking activity-related pain and patient satisfaction tiredness and postoperative nausea and vomiting (PONV) prophylaxis were evaluated In addition functional parameters were analysed that means patients were asked how much pain affected their ability to move in bed their ability to sleep and their mood in the last 24 h hours after surgery The healthcare team was informed on any results and suggested improvements Every staff member involved in pain management had educational lessons every 3 months and a special pain nurse was trained in each ward The data shown here were internally analyzed for each ward to be able to give a direct feedback to the ward of the respective patient Additional lessons were given in the case of deteriorating standards or a turnover in staff because of ward restructuring Nurses received lessons in general pain management in pain treatment required by patients after TKA and pharmacological training according to our standards in pain management Nurses were encouraged to use all treatment options available and were informed about possible risks we emphasized the importance of using non-pharmacological therapeutic possibilities such as cooling the wound and different positioning of the patients as well as of communication with the patient and between nurse and physician patients were asked to report pain to the nurses as early as possible and not try to bear the pain Statistical analysis was done with SPSS (IBM SPSS Statistics All single results were divided into intervals of 3 months (quarter of a year) to establish a timeline Metric variables were reported descriptively as mean and standard deviation Statistical data were not normally distributed Non-parametric Mann-Whitney U tests were used to compare continuous variables between resulting independent subgroup pairs and the Kruskal-Wallis test to compare results between multiple subgroups Pearson’s Chi-square tests were used to compare categorized data of independent subgroups Analyses included the chi square test and the non-parametric Mann-Whitney U test to compare the effects Statistical significance was set at a level of P < 0.05 With a sample size of n = 112 in 2014 compared to n = 144 in 2015 we had 80% power to detect an effect size of d = 0.35 Minimum pain started at a mean NRS of 1.25 (±1.37) and nearly permanently decreased to a value of 0 (±0) over the last two quarters of 2015, which represented significant improvement (p < 0.001) (Fig. 1) Activity-related pain overall followed the curve of maximum pain. Starting at a mean of 4.50 (±2.50), a first decrease was followed by an increase to 5.00 (±2.45). In the 1st quarter of 2015, the score dropped to 1.91 (±1.23) and remained constant at 1.86 (±1.07) until the end of the surveillance period. This improvement was also significant (p < 0.001) (Fig. 1) an (non-significant) increase in the use of piritramid and tramadol could be noticed Patient satisfaction was also recorded on a NRS. At the beginning, patient satisfaction was 8.55 (±1.54), rising continuously to 9.77 (±0.56) in the 1st quarter of 2015 that was followed by a small bend. After that, the patient satisfaction score remained nearly constant at 1.86 (±1.07) until the end of the study (p = 0.001) (Fig. 2). Timeline of mean NRS patient satisfaction (a,b) Comparison of mean NRS activity-related pain among 47 anonymized hospitals in 2014 (a) and 2015 (b). The red bar shows our hospital. (a,b) Comparison of mean NRS patient satisfaction among 47 anonymized hospitals in 2014 (a) and 2015 (b) In this study we wanted to show that pain management can be improved by consistent benchmarking and implementation of a pain management concept including feedback from and to educated staff and that such improvements subsequently reduce postoperative pain and improve patient satisfaction pharmacological standards and surgical methods − both highly influential factors on postoperative pain − have seen many improvements we focused on benchmarking in a standardized setting First positive results were seen rather soon because the NRS for maximum and minimum pain had decreased at the end of the 2nd quarter of 2014 Patient satisfaction had also increased immediately staff training was set back to normal because the time needed for additional training had been difficult to integrate into clinical routine in the first 6 months and all parameters worsened over the next period of data collection Because of this relapse and the impending recertification the decision to cut down on staff training was revised and training lessons were again intensified Particularly newly appointed physicians and nurses got extra lessons to perform better within our pain management concept which significantly decreased all pain scales as well as side-effects in 2015 the educational program was driven by staff demand our department ranked 1st in activity-related pain and 2nd in patient satisfaction in the inter-hospital comparison These positive results were reached without increasing the negative side-effects significantly Outside Germany, the corresponding project PAIN OUT (www.pain-out.eu) offers a similar tool for feedback and benchmarking The implementation of continuous benchmarking has been shown to help decrease postoperative pain in all types of surgical treatment Collecting postoperative data may aid the recognition and solving of any existing problems Even in countries without such a nationwide project single hospitals or associated hospitals may implement benchmarking by comparing the data of different wards within the hospital Wards or hospitals with lower marks could benefit from the experience of those with higher marks a longer follow-up should be planned for further studies This would offer the possibility to observe functional parameters (e.g. patients were only interviewed Tuesdays to Fridays because on weekends no pain nurse was available to collect data This study showed successful improvements in postoperative pain management by establishing a CQI process that we have been using in clinical routine for over 2 years All parameters of process and outcome quality improved in the first interval of the observation period and remained constant for over 1 year Our results suggest that − next to standardized high-quality pharmacological treatment − interdisciplinary teamwork and benchmarking with direct feedback mechanisms might be also very important for decreasing postoperative pain and for increasing patient satisfaction after TKA first improvements should not lead to complacency Implementing a benchmarking and feedback concept decreases postoperative pain after total knee arthroplasty: A prospective study including 256 patients Publisher's note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations Procedure-specific risk factor analysis for the development of severe postoperative pain Postoperative analgesia and functional recovery after total-knee replacement: comparison of a continuous posterior lumbar plexus (psoas compartment) block and the combination of a continuous femoral and sciatic nerve block New and evidence-based aspects of postoperative pain therapy A procedure-specific systematic review and consensus recommendations for postoperative analgesia following total knee arthroplasty Continuous psoas and sciatic block after knee arthroplasty: good effects compared to epidural analgesia or i.v opioid analgesia: a prospective study of 63 patients Femoral nerve blocks for acute postoperative pain after knee replacement surgery The value of adding sciatic block to continuous femoral block for analgesia after total knee replacement Regional anaesthesia and analgesia for total knee replacement Anasthesiol Intensivmed Notfallmed Schmerzther 41 and perceptions of post-surgical pain: results from a US national survey What Influences How Patients Rate Their Hospital After Total Knee Arthroplasty Current concepts and practice in postoperative pain management: need for a change Interprofesssional collaboration: nurses on the team Nurse′s role in the multidisciplinary consultation for pain Quality improvement in postoperative pain management: results from the QUIPS project Benchmarking as a tool of continuous quality improvement in postoperative pain management Quality of pain treatment after caesarean section: Results of a multicentre cohort study External validity of pain-linked functional interference: are we measuring what we want to measure Quality of postoperative pain management after midfacial fracture repair-an outcome-oriented study Postoperative pain assessment after septorhinoplasty The use of different research methodologies to evaluate the effectiveness of programmes to improve the care of patients in postoperative pain A practitioner′s guide to persuasion: an overview of 15 selected persuasion theories From theory to application and back again: implications of research on medical expertise for psychological theory Course of pain after operative orthopedic interventions: Characterization exemplified by total knee arthroplasty Download references We thank Monika Schöll for the linguistic review of our manuscript and Melanie Schmidt for collecting the data Department of Anesthesiology and Intensive Care All authors have made substantial contributions to the study were responsible for the conception and design of the study the interpretation of the data and the drafting of the article interpreted the data and helped to critically revise the data for important intellectual content analyzed and critically revised the data for important intellectual content All authors read and approved the final version of the article to be submitted The authors declare no competing financial interests Download citation Anyone you share the following link with will be able to read this content: a shareable link is not currently available for this article European Journal of Orthopaedic Surgery & Traumatology (2023) Archives of Orthopaedic and Trauma Surgery (2017) Sign up for the Nature Briefing: Translational Research newsletter — top stories in biotechnology The ceremony was performed by Priest Schmidbauer and was followed by a reception at Ritterschenke Restaurant at the Castle Randeck Rohn is the daughter of Dagmar and Hans Koebler of Saal She is employed in the export department at Erlus Baustoffwerke AG Markus Rohn is the son of Gertrud and Werner Rohn of Kelheim He is an electrical engineer for Zweckverband Haefen (port of Kelheim) Bridesmaids were Marlies Guhr of Regensburg Germany and Andrea Schindlbeck of Bad Abbach Germany and Martin Koebler of San Francsico Music was provided by the Ihrlerstein Church Choir; Regina Menath-Kuerzinger Update Note: The World's Best Hospitals 2020 is available here. The Johns Hopkins Hospital - This hospital reported discrepancies in the medical KPI data that was used to determine scores so no medical KPI was used to determine the score for this hospital This score relies only results from patient surverys and recommendations from medical experts Glasglow Royal Infirmary - Medical KPI data that was used for evaluation of hospital in the UK was not available for this hospital This score relies only on results from patient surveys and recommendations from medical experts Royal Infirmary of Edinburgh at Little France - Medical KPI data that was used for evaluation of hospitals in the UK was not available for this hospital Newsletters in your inbox See all