Impact of individualized pain plan on the emergency management of children with sickle cell disease

Abstract

Individualized pain management plans in the ED are effective in delivering high quality management of VOC and are associated with a high level of patient satisfaction and decreased avoidable hospitalizations.

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.…”

“…We also demonstrated an association between shorter time to receiving a second dose of opiate and decreased likelihood of admission. Providing the first parenteral opiate pain medicine within 60 min of arrival has been identified as an important quality metric for care of acute vaso‐occlusive pain in the ED and our institution had times well below 60 min even prior to initiation of our initiative . IPPs have previously been shown to reduce pain scores and increase patient satisfaction.…”

Saudi SCD patients’ symptoms and quality of life relative to the number of ED visits

“…This increases the risks for infections and other health complications that require emergency intervention [15–17]. In particular, high rates of ED utilization have been reported in single and multi-institutional studies [4, 6, 7, 11, 18–24]. The predictors of frequent ED utilization are not fully understood [20], but the following variables have been found to be associated with higher ED and hospital utilization: (1) the more severe disease and disease-related complications, (2) the need for pain crisis management [25], (3) higher white blood cell counts, (4) lower hemoglobin levels, (5) asthma, (6) being publically insured, (7) being 18 to 30 years old, and (8) the inability to obtain follow-up appointments with hematology.…”

Impact of early analgesia on hospitalization outcomes for sickle cell pain crisis

“…In a recent pediatric VOC trial in the ED setting, an association between earlier initial opioid dosing in the ED and length of hospitalization was not identified . However, other studies have suggested that individualized pain management plans in the ED are associated with decreased hospital admission rates, shorter hospitalization, and higher levels of patient satisfaction . Similarly, an adult ED study suggested that a patient‐specific opioid dosing strategy allowed a greater reduction in pain scores and lower admission rates for acute pain than those treated with standard weight‐based dosing strategies .…”