Does e-pain plan improve management of sickle cell disease associated vaso-occlusive pain crisis? A mixed methods evaluation

A novel approach to reducing admissions for children with sickle cell disease in pain crisis through individualization and standardization in the emergency department

“…Our post‐intervention admission rate of 41% is lower that what has been previously reported in the literature. Previous studies of VOC in children have reported admission rates between 50 and 78% . We estimate that 49 admissions and 307 inpatient days are avoided annually through the initiative.…”

“…We found the high admission rates for patients presenting with VOC both locally (50–57%) and nationally (50–78%) to be unacceptable. At our center, we observed an inconsistent approach to pain management both in the ED and after admission.…”

“…Previous studies of VOC in children have reported admission rates between 50 and 78%. [4][5][6][7] We estimate that 49 admissions and 307 inpatient days are avoided annually through the initiative. We also demonstrated an association between shorter time to receiving a second dose of opiate and decreased likelihood of admission.…”

“…Several strategies have been attempted to reduce the burden of VOC through standardizing care. Standardized care pathways have previously been shown to improve time to first opiate dose, increased ketorolac use, and pain scores, but most have not reduced admission rate . Attempts have also been made to individualize care for these children.…”

“…Standardized care pathways have previously been shown to improve time to first opiate dose, increased ketorolac use, and pain scores, but most have not reduced admission rate. 4,5 Attempts have also been made to individualize care for these children. One study showed a reduced admission rate with the use of individualized pain plans (IPPs).…”