SICKLE CELL PATIENT AND PARENT SATISFACTION WITH PAIN MANAGEMENT IN THE EMERGENCY DEPARTMENT

Sickle cell disease (SCD) is associated with significant morbidity, mortality and impaired quality of life. Vaso-occlusive pain crises are the hallmark of sickle cell disease and require frequent visits to the emergency room and admissions to the hospital. Even though national guidelines are available that address the ethical issues of pain management, patients with SCD often receive suboptimal pain control, especially during acute painful episodes. This project planned to determine some methods of improving patient care and satisfaction of pain management in hopes of being able to translate these methods to other health care systems.At the Children's Hospital of Pittsburgh (CHP) individualized pain plans, which include lists of each patient's most recent pain medications, have been in place since 2002. Retrospective data was analyzed to determine whether admission rates have decreased since this time due to improved care and treatment of patients with SCD. Additionally, patient and parent satisfaction with current pain management was evaluated by the use of surveys, with questions regarding overall perceptions of treatment and care. We had also proposed to implement a quality improvement program in the ED to further improve care of patients with sickle cell disease presenting with vaso-occlusive pain crises and then reassess patient and parent satisfaction. However, time restraints did not allow a quality improvement program to be implemented at this time.This study found that admission rates since 2002 had decreased at CHP, since the time that individualized pain plans were designed and put into practice. Baseline measurements of patient and parent satisfaction found that, overall, participants were satisfied with the care and treatment of pain they received in the ED. Future studies should involve developing further methods of improving patient satisfaction with pain management; a possible avenue to pursue may be working on decreasing wait times in the ED.The public health significance of this research is that increasing satisfaction by improved care, treatment, and pain management may lead to improved quality of life for patients with SCD; additionally, similar steps to be taken in other hospitals to increase the level of pain management that sickle cell patients receive.