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


Journal Article

BACKGROUND:Guidelines recommend rapid, aggressive management of vaso-occlusive crisis (VOC) for patients with sickle cell disease (SCD). A large prospective research and quality improvement (QI) project was conducted to measure changes in clinical outcomes in two EDs-academic medical centers with emergency medicine residency programs and Level 1 trauma centers-during a 2.5-year time period (October 2011-March 2014). METHODS:A QI team used a Plan-Do-Study-Act approach to modify and implement changes to opioid analgesic protocols for the emergency department (ED) treatment of VOC. Data were collected quarterly; the team reviewed the results and made modifications to improve outcomes. A structured health record review was conducted to assess clinical outcomes (10 records/quarter/site). Patient interviews were conducted to measure satisfaction with pain management. Outcomes were compared before (T1) and after (T2) implementation of an electronic health record (EHR). RESULTS:One hundred ninety-six ED health records (118 unique patients, mean age = 32 [standard deviation, 11], 51% male) were analyzed. Before implementation, trends in decreasing time to initial analgesic administration were noted. There was a statistically significant increase in arrival to administration of first analgesic time between T1 and T2 at Site 1 but not at Site 2. Neither site showed significant changes in time between the administration of the first and second opioid doses, total opioid dose administered, or patient satisfaction. CONCLUSION:While QI efforts initially shortened door-to-analgesic times, these gains were not sustained. The lessons learned can help other EDs improve the timely delivery of analgesics to patients with SCD.

Full Text

Duke Authors

Cited Authors

  • Tanabe, P; Freiermuth, CE; Cline, DM; Silva, S

Published Date

  • March 2017

Published In

Volume / Issue

  • 43 / 3

Start / End Page

  • 116 - 126

PubMed ID

  • 28334590

Pubmed Central ID

  • 28334590

Electronic International Standard Serial Number (EISSN)

  • 1938-131X

International Standard Serial Number (ISSN)

  • 1553-7250

Digital Object Identifier (DOI)

  • 10.1016/j.jcjq.2016.12.005


  • eng