A Prospective Emergency Department Quality Improvement Project to Improve the Treatment of Vaso-Occlusive Crisis in Sickle Cell Disease: Lessons Learned

Tanabe, Paula; Freiermuth, Caroline E.; Cline, David; Silva, Sílvia Agostinho da

doi:10.1016/j.jcjq.2016.12.005

Cited by 7 publications

(7 citation statements)

References 25 publications

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“…Since the release of these guidelines, numerous studies have reported delays in the management of sickle cell pain. [11][12][13][14][15] Delays are often due to ED overflow, difficulty obtaining IV access, delayed order placement, assignment of triage levels, etc. 11,12,16,17 Notably, the median time from arrival to initial analgesic administration in pediatric patients with SCD is approximately 90 minutes.…”

Section: Introductionmentioning

confidence: 99%

The association between timely opioid administration and hospitalization in children with sickle cell disease presenting to the emergency department in acute pain

Muslu

Kopetsky²,

Nimmer

et al. 2020

Pediatric Blood & Cancer

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Introduction The National Heart, Lung, and Blood Institute guidelines for sickle cell disease (SCD) pain crisis management recommend opioids within 60 minutes of emergency department (ED) registration and every 30 minutes thereafter until acute pain is managed. These guidelines are based on expert opinion without published, supporting data. Objective To evaluate the association between timely ED opioid administration and hospitalization rates in children with SCD. Methods Retrospective cohort of children presenting to a children's hospital ED with SCD pain between January 1, 2014, and April 30, 2018. Visits were extracted using ICD codes, chief complaints, and receipt of at least one opioid, and then reviewed to confirm the visit was an uncomplicated pain crisis. The primary outcome was hospitalization, yes or no. Generalized estimating equations were used to determine adjusted odds of hospitalization for the timely administration of initial and second doses of opioids. Results Of the 902 eligible visits, 368 (40.8%) resulted in hospitalization. The mean (SD) age was 11.9 (± 5.2) years. The first opioid was administered within 60 minutes of arrival in 601 (66.6%) visits. The second opioid was administered within 30 minutes of the first in 84 (12.3%) visits. Receipt of the first opioid within 60 minutes of arrival was not associated with decreased hospitalization (1.30 [0.96‐1.76]). However, receipt of the second dose within 30 minutes of the first was associated with decreased hospitalization (0.56 [0.33‐0.94]). Conclusion This study suggests an association between children with SCD receiving a second dose within 30 minutes of the first opioid dose and decreased hospitalizations.

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Section: Introductionmentioning

confidence: 99%

The association between timely opioid administration and hospitalization in children with sickle cell disease presenting to the emergency department in acute pain

Muslu

Kopetsky²,

Nimmer

et al. 2020

Pediatric Blood & Cancer

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“…Data for this project were reported in the context of a two-center QI project. 17 , 18 Details of the project have been published. 17 – 20 Briefly, the project attempted to optimize the treatment of VOC in the ED using best practices, 1 while monitoring healthcare utilization and psychosocial referral needs and practices.…”

Section: Methodsmentioning

confidence: 99%

“… 17 , 18 Details of the project have been published. 17 – 20 Briefly, the project attempted to optimize the treatment of VOC in the ED using best practices, 1 while monitoring healthcare utilization and psychosocial referral needs and practices. 17 – 19 In this paper, we report acute healthcare utilization data only (excluding the number of clinic visits).…”

Section: Methodsmentioning

confidence: 99%

“…Patient satisfaction with pain medication (reported previously) was not significantly different between sites. 17 …”

Section: Limitationsmentioning

confidence: 99%

“…In the context of a two-center quality improvement (QI) project designed to implement best practices for the ED management of patients with complications of sickle cell disease, 17 , 18 we had a unique opportunity to prospectively examine the impact of different utilization rates of DH care, and/or EDOU care on rates of hospital admission for patients with sickle cell anemia experiencing VOC. We also had the opportunity to assess ED encounters and hospitalizations for our two cohorts of patients at outside centers within a 20-mile radius of each study site, an aspect of care rarely reported on.…”

Section: Introductionmentioning

confidence: 99%

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Emergency Department (ED), ED Observation, Day Hospital, and Hospital Admissions for Adults with Sickle Cell Disease

Cline¹,

Silva

Freiermuth

et al. 2018

WestJEM

Self Cite

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IntroductionUse of alternative venues to manage uncomplicated vaso-occlusive crisis (VOC), such as a day hospital (DH) or ED observation unit, for patients with sickle cell anemia, may significantly reduce admission rates, which may subsequently reduce 30-day readmission rates.MethodsIn the context of a two-institution quality improvement project to implement best practices for management of patients with sickle cell disease (SCD) VOC, we prospectively compared acute care encounters for utilization of 1) emergency department (ED); 2) ED observation unit; 3) DH, and 4) hospital admission, of two different patient cohorts with SCD presenting to our two study sites. Using a representative sample of patients from each institution, we also tabulated SCD patient visits or admissions to outside hospitals within 20 miles of the patients’ home institutions.ResultsOver 30 months 427 patients (297 at Site 1 and 130 at Site 2) initiated 4,740 institutional visits, totaling 6,627 different acute care encounters, including combinations of encounters. The range of encounters varied from a low of 0 (203 of 500 patients [40.6%] at Site 1; 65 of 195 patients [33.3%] at Site 2), and a high of 152 (5/month) acute care encounters for one patient at Site 2. Patients at Site 2 were more likely to be admitted to the hospital during the study period (88.4% vs. 74.4%, p=0.0011) and have an ED visit (96.9% vs. 85.5%, p=0.0002). DH was used more frequently at Site 1 (1.207 encounters for 297 patients at Site 1, vs. 199 encounters for 130 patients at Site 2), and ED observation was used at Site 1 only. Thirty-five percent of patients visited hospitals outside their home academic center.ConclusionIn this 30-month assessment of two sickle cell cohorts, healthcare utilization varied dramatically between individual patients. One cohort had more hospital admissions and ED encounters, while the other cohort had more day hospital encounters and used a sickle cell disease observation VOC protocol. One-third of patients sampled visited hospitals for acute care outside of their care providers’ institutions.

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Key Components of Pain Management for Children and Adults with Sickle Cell Disease

Brandow

DeBaun

2018

Hematology/Oncology Clinics of North America

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Sickle cell disease pain manifests as severe acute pain episodes and a debilitating chronic pain syndrome. Acute pain episodes are the most common reason for health care use; however, acute pain episodes are also frequently managed at home. Chronic pain syndrome develops in 30% to 40% of individuals with sickle cell disease, with an increasing incidence and severity with age. We review the critical aspects of pain management that are integral to the comprehensive approach to sickle cell disease pain and are rooted in the biopsychosocial model. The review focuses on opioid pharmacology and psychosocial comorbidities.

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A Prospective Emergency Department Quality Improvement Project to Improve the Treatment of Vaso-Occlusive Crisis in Sickle Cell Disease: Lessons Learned

Cited by 7 publications

References 25 publications

The association between timely opioid administration and hospitalization in children with sickle cell disease presenting to the emergency department in acute pain

The association between timely opioid administration and hospitalization in children with sickle cell disease presenting to the emergency department in acute pain

Emergency Department (ED), ED Observation, Day Hospital, and Hospital Admissions for Adults with Sickle Cell Disease

Key Components of Pain Management for Children and Adults with Sickle Cell Disease

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