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A novel approach to reducing admissions for children with sickle cell disease in pain crisis through individualization and standardization in the emergency department
Author(s) -
Schefft Matthew R.,
Swaffar Caitlan,
Newlin Jennifer,
Noda Cady,
Sisler India
Publication year - 2018
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.27274
Subject(s) - medicine , emergency department , dosing , vaso occlusive crisis , opiate , pdca , emergency medicine , medical record , pediatrics , disease , quality management , sickle cell anemia , psychiatry , management system , receptor , management , economics
Background Vaso‐occlusive crisis (VOC) is frequent in children with sickle cell disease (SCD) creating significant burden on patients, families, and emergency departments (ED). The objective of the project was to reduce the admission rate for children with SCD presenting to our ED with VOC by >20% within 6 months of initiating individualized pain plans (IPP). Methods A multi‐disciplinary quality improvement team was assembled. A Plan‐Do‐Study‐Act (PDSA) format was employed. The IPP document was created in a unique folder within the electronic medical record. IPPs were created through retrospective chart review for our 80 highest resource users. Pediatric residents, ED residents, and ED attending physicians were instructed on use of the IPPs. Our study measured the presence of an IPP, adherence to the IPP, and time to opiate administration. Our primary outcome was admission rate. Length of stay and 72‐hr return to the ED were assessed as balancing measures. Results Overall, admission rate decreased by 24% following implementation compared with the previous 5 years ( P = 0.046). IPPs were created for 78% of patients and followed by ED staff in 86% of visits. Admission rate was significantly lower for patients receiving a second opiate dose within 45 min of the first dose ( P < 0.01). There was no difference in readmission rate or 72‐hr return rate to ED. Conclusions This study presents an effective strategy to reduce admission rate for children with SCD presenting with VOC. Shorter time to second opiate dosing was also associated with reduced risk of admission.