Advancing Hospital Service Quality and Operational Effectiveness through Evidence-Based Analgesic Protocols

JEL Classification: I11, I12, I18, L15, M11, D24

  • Andi Hermawan Master of Hospital Administration, Faculty of Medicine, Universitas Muhammadiyah Surakarta, Surakarta, Indonesia
  • Yusuf Alam Romadhon Master of Hospital Administration, Faculty of Medicine, Universitas Muhammadiyah Surakarta, Surakarta, Indonesia
  • Imronudin Study Program of Management, Faculty of Economics and Business, Universitas Muhammadiyah Surakarta, Surakarta, Indonesia
Keywords: Epidural Levobupivacaine, Patient Satisfaction, Pain Management, Syringe Pump Fentanyl, Total Knee Replacement

Abstract

The study is aimed at comparing the clinical and institutional outcomes of using two postoperative analgesics regimens, Epidural Levobupivacaine and Syringe Pump Fentanyl, and how these drugs interfere with analgesia control and resource consumptions, patient satisfactory, and system performance. A comparative observational research design was used which covered 60 patients of Total Knee Replacement (TKR) who were in a tertiary orthopedic center. The participants were at random allocated to an Epidural Levobupivacaine or Fentanyl protocol. The collected data included pain scores, adverse events, the readiness of the patient to leave, and satisfaction questionnaires and efficiencies of hospitals in terms of data. The data were analyzed using descriptive and comparative approaches. The Epidural group of patients recorded less pain scores, fewer adverse effects, earlier mobilization and shorter length of stay. The scores of the satisfaction on pain control, comfort and responsiveness were significantly more in the Epidural group. The mode of operation also demonstrated better nursing efficiency and discharge planning, and risk indicators were reduced, e.g. escalation to high-dependency care, with the use of the epidural protocol. Epidural Levobupivacaine represents an effective operational and clinical performance that demonstrates that it can be used as a strategical standar in elective orthopedis care based on systemic opioids. In addition to the analgesic effectiveness, the protocol improves institutional efficiency, minimizes the clinical risk, intensifies patient experience and fits the contemporary performance-based healthcare provision. Pain management must therefore be redefined as an impact component that has a cross-functional component of hospital service design.

References

A. Rahim, A. I., Ibrahim, M. I., Musa, K. I., Chua, S. L., & Yaacob, N. M. (2021). Assessing patient-perceived hospital service quality and sentiment in malaysian public hospitals using machine learning and facebook reviews. International journal of environmental research and public health, 18(18), 9912. https://doi.org/10.3390/ijerph18189912

Abd El-Rahman, E., Ezzat, E., & Abdelaziz, A. (2023). Enhanced Recovery after Surgery (ERAS). Benha Journal of Applied Sciences, 8(8), 71-81. http://dx.doi.org/10.21608/bjas.2023.229250.1229

Aiken, L. H., Clarke, S. P., Sloane, D. M., & International Hospital Outcomes Research Consortium. (2002). Hospital staffing, organization, and quality of care: cross-national findings. International Journal for quality in Health care, 14(1), 5-14. https://doi.org/10.1067/mno.2002.126696

Al Munif, S. (2025). The Patient Reported Indicators Survey (PaRIS) in Saudi Arabia: Measuring Patient Reported Outcomes and Experiences in Adults Aged 18-44 (Doctoral dissertation, New York University College of Global Public Health).

Alqaisi, O. M., Al-Ghabeesh, S., & Alqaisi Sr, O. (2024). Quality of Postoperative Pain Management in Orthopedic patients and its impact on Sleep Quality and patient satisfaction: an integrative review. Cureus, 16(7). https://doi.org/10.7759/cureus.65872

Alrashidi, N., Pasay an, E., Alrashedi, M. S., Alqarni, A. S., Gonzales, F., Bassuni, E. M., ... & Ahmed, K. E. (2023). Effects of simulation in improving the self-confidence of student nurses in clinical practice: a systematic review. BMC Medical Education, 23(1), 815. https://doi.org/10.1186/s12909-023-04793-1

Anabila, P., Kumi, D. K., & Anome, J. (2019). Patients’ perceptions of healthcare quality in Ghana: A review of public and private hospitals. International journal of health care quality assurance, 32(1), 176-190. http://dx.doi.org/10.1108/IJHCQA-10-2017-0200

Bamgbade, O. A., Sonaike, M. T., Adineh-Mehr, L., Bamgbade, D. O., Aloul, Z. S., Thanke, C. B., ... & Chansa, M. (2024). Pain Management and Sociology Implications: The Sociomedical Problem of Pain Clinic Staff Harassment Caused by Chronic Pain Patients. Anesthesiology and Pain Medicine, 14(2), e144263. https://doi.org/10.5812/aapm-144263

Brennan, F., Carr, D. B., & Cousins, M. (2007). Pain management: a fundamental human right. Anesthesia & Analgesia, 105(1), 205-221. https://doi.org/10.1213/01.ane.0000268145.52345.55

Bueno-Gómez, N. (2017). Conceptualizing suffering and pain. Philosophy, Ethics, and Humanities in Medicine, 12, 1-11. https://doi.org/10.1186/s13010-017-0049-5

Chen, Y. Y., Boden, K. A., & Schreiber, K. (2021). The role of regional anaesthesia and multimodal analgesia in the prevention of chronic postoperative pain: a narrative review. Anaesthesia, 76, 8-17. https://doi.org/10.1111/anae.15256

Desai, M. M., Shahare, P. Y., Chopade, R., & Shere, P. (2023). Assessment Patient Satisfaction after Total Knee Replacement in Indian Population. International Journal of Research in Orthopaedics, 9(3), 531–535. https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20231178

Devin, C. J., & McGirt, M. J. (2015). Best evidence in multimodal pain management in spine surgery and means of assessing postoperative pain and functional outcomes. Journal of Clinical Neuroscience, 22(6), 930-938. https://doi.org/10.1016/j.jocn.2015.01.003

Dobesh, P. P. (2009). Economic burden of venous thromboembolism in hospitalized patients. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 29(8), 943-953. https://doi.org/10.1592/phco.29.8.943

Duckett, S., & Willcox, S. (2015). The Australian health care system (No. Ed. 5, pp. 480-pp).

Erden, S., Güler, S., Tura, İ., Başibüyük, İ. F., & Arslan, U. E. (2023). Evaluating patient outcomes in postoperative pain management according to the revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R). Applied Nursing Research, 73, 151734. https://doi.org/10.1016/j.apnr.2023.151734

Gao, L., Mu, H., Lin, Y., Wen, Q., & Gao, P. (2023). Review of the current situation of postoperative pain and causes of inadequate pain management in Africa. Journal of Pain Research, 1767-1778. https://doi.org/10.2147/JPR.S405574

Garampalli, A., Patil, A., & Quadri, M. (2020). Our Experience of Total Knee Arthroplasty in Rural Karnataka Region. International Journal of Orthopaedics Sciences, 6(1), 1082–1088. https://doi.org/10.22271/ortho.2020.v6.i1n.1966

Grela, M., Barrett, M., Kunutsor, S. K., Blom, A. W., Whitehouse, M. R., & Matharu, G. S. (2022). Clinical Effectiveness of Patellar Resurfacing, No Resurfacing and Selective Resurfacing in Primary Total Knee Replacement: Systematic Review and Meta-Analysis of Interventional and Observational Evidence. BMC Musculoskeletal Disorders, 23(1), 932. https://doi.org/10.1186/s12891-022-05877-7

Hakam, M., Kushariyadi, K., & Pribadi, N. I. P. C. (2024). Literature Review : Gambaran Tindakan Perawat Mengatasi Nyeri Pasien Post Operasi Laparatomi Di Rumah Sakit. Bima Nursing Journal, 5(2), 95–106. https://doi.org/10.32807/bnj.v5i2.1295

Ibitomi, T., Dada, D. A., Igbokwe, P. I., & Ibitoye, G. (2024). Talent management and service quality among deposit money banks in Ondo State, Nigeria. International Journal of Development and Sustainability, 13(1), 1-21.

Jain, S. N., Lamture, Y., & Krishna, M. (2023). Enhanced recovery after surgery: exploring the advances and strategies. Cureus, 15(10). https://doi.org/10.7759/cureus.47237

Jesus, T. S., Lee, D., Zhang, M., Stern, B. Z., Struhar, J., Heinemann, A. W., ... & Deutsch, A. (2025). Organizational and Service Management Interventions for Improving the Patient Experience With Care: Systematic Review of the Effectiveness. The International Journal of Health Planning and Management. https://doi.org/10.1002/hpm.3916

Kahlenberg, C. A., Nwachukwu, B. U., McLawhorn, A. S., Cross, M. B., Cornell, C. N., & Padgett, D. E. (2018). Patient Satisfaction after Total Knee Replacement: A Systematic Review. HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery, 14(2), 192–201. https://doi.org/10.1007/s11420-018-9614-8

Kehlet, H., & Wilmore, D. W. (2008). Evidence-based surgical care and the evolution of fast-track surgery. Annals of surgery, 248(2), 189-198. https://doi.org/10.1097/sla.0b013e31817f2c1a

Lavand’homme, P. M., Kehlet, H., Rawal, N., & Joshi, G. P. (2022). Pain Management after Total Knee Arthroplasty. European Journal of Anaesthesiology, 39(9), 743–757. https://doi.org/10.1097/EJA.0000000000001691

Maryani, N. T., & Adi, N. P. D. (2021). Analisis Strategi Pemasaran pada Pelayanan Operasi Penggantian Sendi Lutut. Jurnal ARSI : Administrasi Rumah Sakit Indonesia, 7(3), 95–101. https://doi.org/10.7454/arsi.v7i3.3659

Mawarti, Y., Utarini, A., & Hakimi, M. (2017). Maternal care quality in near miss and maternal mortality in an academic public tertiary hospital in Yogyakarta, Indonesia: a retrospective cohort study. BMC pregnancy and childbirth, 17, 1-8. https://doi.org/10.1186/s12884-017-1326-4

Niyonkuru, E., Iqbal, M. A., Zhang, X., & Ma, P. (2025). Complementary approaches to postoperative pain management: a review of non-pharmacological interventions. Pain and therapy, 14(1), 121-144. https://doi.org/10.1007/s40122-024-00688-1

Niyonkuru, E., Iqbal, M. A., Zhang, X., & Ma, P. (2025). Complementary approaches to postoperative pain management: a review of non-pharmacological interventions. Pain and therapy, 14(1), 121-144. https://doi.org/10.1007/s40122-024-00688-1

Oliver, R. L. (1980). A cognitive model of the antecedents and consequences of satisfaction decisions. Journal of marketing research, 17(4), 460-469. https://psycnet.apa.org/doi/10.2307/3150499

Pennestrì, F., & Banfi, G. (2023, July). Primary care of the (near) future: Exploring the contribution of digitalization and remote care technologies through a case study. In Healthcare (Vol. 11, No. 15, p. 2147). MDPI. https://doi.org/10.3390/healthcare11152147

Pirie, K., Traer, E., Finniss, D., Myles, P. S., & Riedel, B. (2022). Current approaches to acute postoperative pain management after major abdominal surgery: a narrative review and future directions. British Journal of Anaesthesia, 129(3), 378-393. https://doi.org/10.1016/j.bja.2022.05.029

Porter, M. E., & Lee, T. H. (2013). The strategy that will fix health care. Harv Bus Rev, 91(10), 50-70.

Pristianto, A., Raharjo, T. D., & Setiyaningsih, R. (2019). Case Report: Intervensi Fisioterapi dalam Peningkatan Kemampuan Fungsional Pasien pasca Total Knee Replacement et causa Gonitis Tuberkulosis di RS Orthopedi Prof. Dr. Soeharso Surakarta. He 10th University Research Colloqium 2019 Sekolah Tinggi Ilmu Kesehatan Muhammadiyah Gombong, 978–987.

Resky, S. D., Muhajrin, M., & Irwan, I. (2024). Analisis Kualitas Pelayanan Tenaga Administrasi Rumah Sakit terhadap Kepuasan Pasien di Unit Instalasi Rawat Jalan di Rumah Sakit. Journal of Educational Innovation and Public Health, 2(2), 134–148. https://doi.org/10.55606/innovation.v2i2.3127

Sawicki, C. M., Humeidan, M. L., & Sheridan, J. F. (2021). Neuroimmune interactions in pain and stress: an interdisciplinary approach. The neuroscientist, 27(2), 113-128. https://doi.org/10.1177/1073858420914747

Slominski, A. T., Slominski, R. M., Raman, C., Chen, J. Y., Athar, M., & Elmets, C. (2022). Neuroendocrine signaling in the skin with a special focus on the epidermal neuropeptides. American Journal of Physiology-Cell Physiology, 323(6), C1757-C1776. https://doi.org/10.1152/ajpcell.00147.2022

Suharyono, S., Dewi, Y. S., & Pratiwi, I. N. (2021). Pengaruh Rehabilitasi Berbasis Virtual Reality dalam Menurunkan Intensitas Nyeri pada Pasien Pasca Bedah Ortopedi: Systematic Review. Jurnal Penelitian Kesehatan “SUARA FORIKES” (Journal of Health Research “Forikes Voice”), 12(4), 391–397. https://doi.org/10.33846/SF.V12I4.1488

Tifani, M. (2022). Pengaruh Kualitas Pelayanan Tenaga Administrasi Rumah Sakit terhadap kepuasan Pasien di Unit Instalasi Rawat Jalan Rumah Sakit Umum Daerah Arifin Achmad Provinsi Riau. Universitas Awal Bros.

Verhoeven, D., Siesling, S., Allemani, C., Roy, P. G., Travado, L., Bhoo-Pathy, N., ... & Tucker, F. L. (2024). High-value breast cancer care within resource limitations. The oncologist, 29(7), e899-e909. https://doi.org/10.1093/oncolo/oyae080

Volkow, N. D., & McLellan, A. T. (2016). Opioid abuse in chronic pain—misconceptions and mitigation strategies. New England Journal of Medicine, 374(13), 1253-1263. https://doi.org/10.1056/nejmra1507771

Wang, Y., Aaron, R., Attal, N., & Colloca, L. (2025). An update on non-pharmacological interventions for pain relief. Cell Reports Medicine, 6(2). https://doi.org/10.1016/j.xcrm.2025.101940

Wild, H. M., Busby, A., Mackintosh, L., & Wellsted, D. (2024, September). Patient-Reported Experience Measures to Evaluate and Improve the Quality of Care in Nephrology. In Seminars in nephrology (p. 151551). WB Saunders. https://doi.org/10.1016/j.semnephrol.2024.151551

Xu, J., Liu, X., Zhao, J., Zhao, J., Li, H., Ye, H., & Ai, S. (2025). Comprehensive Review on Personalized Pain Assessment and Multimodal Interventions for Postoperative Recovery Optimization. Journal of Pain Research, 2791-2804. https://doi.org/10.2147/JPR.S516249

Published
2025-07-01
How to Cite
Hermawan, A., Romadhon, Y. A., & Imronudin, I. (2025). Advancing Hospital Service Quality and Operational Effectiveness through Evidence-Based Analgesic Protocols: JEL Classification: I11, I12, I18, L15, M11, D24. Journal La Bisecoman, 6(2), 359-377. https://doi.org/10.37899/journallabisecoman.v6i2.2173