A Quality Improvement Initiative to Decrease Time to Analgesia in Patients With Sickle Cell and Vaso-Occlusive Crisis: A Population With Disparities in Treatment

Abstract

Introduction: Vaso-occlusive crises (VOCs) are the leading cause of emergency department (ED) visits and hospitalizations in patients with sickle cell disease (SCD). Timely administration of analgesia, within 60 minutes of patient registration, is the standard of care for SCD patients with VOCs. Patients with VOCs have longer times to initial analgesia compared to similar painful conditions. The primary aim of the project is to have 75% of patients with VOCs receive initial analgesia within 60 minutes of being registered, the current recommended time frame from the National Heart, Lung, and Blood Institute (NHLBI).Methods: A multi-disciplinary team used quality improvement (QI) methodology to develop a plan involving multiple Plan-Do-Study-Act (PDSA) cycles. A rapid evaluation process was employed which included notification of a patient with a VOC being placed in a room, rapid evaluation by all team members and use of an electronic order set.Results: The aim was met 72% of the time during our intervention period, compared to 17% preintervention. Average time to initial analgesia was decreased from 61 minutes to 42 minutes (p-value < 0.001), while time to disposition was also decreased when time goals were achieved.Conclusion: Using a rapid evaluation process we were able to decrease time to initial analgesia in a patient population that has previously experienced delays in care and decrease overall time to disposition.

A comparison of the effect of patient‐specific versus weight‐based protocols to treat vaso‐occlusive episodes in the emergency department

“…23 PSPs to treat VOC have been found to decrease time to administration of first opioid, overall time to disposition when guidelines are followed, and hospital admission rates. 19,20,22,24,25 Our data support previous data that administration of a PSP and WB opioid protocols are safe. There were no SAEs throughout the current or previous study.…”

“…ED physicians reported being satisfied with the clarity of the order (97.6%), its ability to manage pain (91%), and better than their usual ED strategy (70%) 23 . PSPs to treat VOC have been found to decrease time to administration of first opioid, overall time to disposition when guidelines are followed, and hospital admission rates 19,20,22,24,25 …”

Individuals with Sickle Cell Disease Using SBAR as a Communication Tool: A Pilot Study

“…Patients with SCD face unique challenges during care seeking for pain management in emergency departments. These challenges have been described by patients and HCPs [ 4 , 6 , 7 , 8 , 10 , 13 , 14 , 15 , 16 , 18 , 19 ]. The current study results support using SBAR as a communication tool for patients to communicate with providers in the emergency department.…”

“…SCD typically presents as chronic pain exacerbated by acute episodes known as sickle cell crisis (SCC), requiring pain management [ 3 , 4 ]. However, patients who present in the emergency department (ED) during a pain crisis frequently report delays in care [ 5 , 6 ]. This delay in care often stems from negative past treatment experiences and HCP bias.…”

“…Many patients with SCD report dissatisfaction with the quality of care they receive [ 6 , 8 , 17 , 18 ]. Communication with their HCP has been identified as an essential element of quality care among patients who have SCD [ 17 ].…”