Date of Award

January 2020

Document Type

Open Access Thesis

Degree Name

Doctor of Nursing Practice (DNP)


Yale University School of Nursing

First Advisor

Dena Schulman-Green

Second Advisor

Ruth McCorkle


Introduction: The need for palliative care increases as the number of patients continues to grow due to the aging population and rising cancer rates. Pain management is one of the essential components of palliative care. Anesthesia providers are well-positioned to become active members of palliative care teams and to provide pain management services, including regional and interventional therapies to patients in the acute care setting. Due to lack of awareness of the need, there have been few referrals for these services. Consequently, despite anesthesia providers’ knowledge of pain management and anesthesia care delivery, they have not been consistently involved in contributing to palliative care services.

Purpose: The overall goal of this project was to improve the current referral system of patients to the Smilow Pain Clinic, and as a result to improve access to highly specialized pain management interventions.


1. Two-phase review of literature, pertaining to:

a. palliative care, interventional pain management therapies, and involvement of anesthesia providers;

b. protocols for referral of patients for interventional pain management therapies, general protocols for referral for treatment, components of a protocol, and protocol evaluation.

2. Assessment and evaluation of the current referral system to the Smilow Pain Clinic via the following methods:

a. retrospective chart review of patients referred to the Smilow Pain Clinic;

b. assessment of the frequency of use;

c. interview of providers referring patients to the Smilow Pain Clinic and the receiving providers.

3. Dissemination of findings to appropriate stakeholders, strengthening of the current referral system through application of the assessment findings and evidence-based strategies.

Results: Data revealed varying degrees of understanding of the referral process and its components among providers; consistent expression of the need for education about the referral process, patient selection, and interventions the clinic provides; and opportunities to incorporate data use to drive the referral process. Findings were consistent with the need for an educational intervention for providers pertaining to the referral process.

Conclusion: Implementation of educational interventions (Fast Fact Sheet, educational course, data dashboard creation) has the potential to increase providers’ knowledge level about the referral process and interventional pain management therapies, and as a result increase referral rate to the clinic.


This is an Open Access Thesis.

Open Access

This Article is Open Access