Focus on Comfort - The effect of focus language on postoperative hospital stay compared to the NRS in children receiving postoperative care – A before-after study

Purpose This study evaluates the effect of comfort assessment using focus language compared with pain assessment using the Numeric Rating Scale (NRS) on the postoperative length of stay (LOS), analgesic use and patient and parental satisfaction. Methods This prospective before-after study was conducted on a general pediatric ward at Emma Children’s Hospital. During the pre-intervention period pain was assessed using NRS. After implementation of focus language, comfort was assessed using the new communication approach. Eligible participants were children ≥6 years receiving postoperative care for >24 hours, able to report a NRS. Primary outcome was LOS (hours). Secondary outcomes were analgesic use (hours) and patient and parental satisfaction. Multivariable linear regression was used to adjust for baseline differences, potential confounding and effect modification. Results Pre-intervention 93 patients were included and post-intervention 99. The adjusted mean LOS in the post-intervention group (94.29 hours) was statistically significantly higher than the pre-intervention group (74.13 hours): expβ=1.27, p<0.01. Additional analyzes showed the estimated LOS was significantly higher post-intervention, suggesting more complex surgeries were performed during that period. Therefore, we analyzed the difference between estimated and actual LOS; no statistical significant difference was found. Analgesic use and patient and parental satisfaction were comparable. Conclusion When healthcare professionals focused on comfort during postoperative care, the difference between the estimated actual LOS was not statistical significant, patients received comparable number of analgesics, and patients and parents were equally satisfied. Shifting from pain-focused to comfort-focused communication appears a safe, feasible and promising approach for pediatric postoperative care.