Faculty Bibliography

Acute pain medicine (APM) has been incorporated into healthcare systems in varied manners with some practices implementing a stand-alone acute pain service (APS) staffed by consultants who are not simultaneously providing care in the operating room (OR). In contrast, other practices have developed a concurrent OR-APS model where there is no independent team beyond the intraoperative care providers. There are theoretical advantages of each approach primarily with respect to patient outcomes and financial cost, and there is little evidence to instruct best practice. In this daring discourse, we present two opposing perspectives on whether or not APM should be a stand-alone service. While evidence to guide best practice is limited, our goal is to encourage discussion of the varied APS practice models and research into their impact on outcomes and costs.

PURPOSE: Inferior vena cava (IVC) filter placement has increased significantly over the past few decades, but indications for filter placement vary widely depending on which professional society recommendations are followed, and it is uncertain how compliant physicians are in adhering to guidelines. This study assessed documented indications for IVC filter placement and evaluated compliance with standards set by the American College of Chest Physicians (ACCP) and the Society of Interventional Radiology (SIR). MATERIALS AND METHODS: A single-center, retrospective medical record review in a metropolitan, 652-bed, acute care, teaching hospital. Inpatient filter placement over a 26-month period was reviewed. The study measured compliance with established guidelines, relationship of medical specialty to filter placement, and evaluation of self-referral patterns among physicians. RESULTS: Compliance with established ACCP guidelines was poor regardless of whether the IVC filter insertion was performed by interventional radiology (IR; 43.5%), vascular surgery (VS; 39.9%), or interventional cardiology (IC; 33.3%) staff. Compliance with the less restrictive SIR guidelines was better (77.5%, 77.1%, and 80% for IR, VS, and IC, respectively). There was a greater degree of guideline compliance when filter placement was recommended by internal medicine (IM)-trained physicians than by non-IM-trained physicians: 46.3% of IR-placed filters requested by IM physicians met ACCP criteria whereas only 24.0% of filters recommended by non-IM specialties were compliant with criteria (P = .03). In the VS group, these compliance rates were 45.8% and 31.5%, respectively (P = .03). Among IR-placed filters, 84.0% of IM-recommended filter placements were compliant with SIR guidelines, versus only 48.0% of non-IM-recommended placements (P