Timely Analgesia, Reduced Hospitalization Rate, and Improved Economic Efficiency Following Implementation of a New Emergency Department Sickle Cell Pain Management Algorithm

Abstract

Context: Adults with sickle cell disease (SCD) presenting to emergency departments (EDs) with severe pain often experience treatment delays and long, costly hospitalizations. Objectives: A fast-track ED SCD pain management algorithm was developed and then evaluated for its clinical and economic impact. Methods: We conducted a retrospective chart review to compare outcomes of ED visits for SCD-related pain two years before and after algorithm implementation. Patient demographics, ED utilization, and treatment outcome measures including time from registration to first opioid treatment, ED length of stay, hospitalization rate, hospitalization length of stay, and both hospital and ED revenue production were compared. Results: There was a total of 699 consecutive ED visits for SCD-related pain (131 pre-and 568 postalgorithm). Median time to first opioid dose decreased from 53 to 32 minutes (p <0.001). Disposition was determined more efficiently (210 vs. 168 minutes, p <0.001) leading to reduction in ED length of stay (345 vs. 271 minutes, p<0.001). Although ED utilization increased, this was due to a few high utilizers whose patterns of use skewed the mean. Hospitalization rate per ED visit significantly decreased (54% vs. 38%, p=0.001). Average length of stay per hospitalization decreased from 12 to 8 days (p<0.03) which was economically beneficial to the hospital in that revenue production per inpatient day increased by 28%. Conclusions: Our findings suggest algorithmic ED SCD pain management significantly improves quality and economic outcomes.