A Quality Improvement Initiative to Improve Emergency Department Care for Pediatric Patients with Sickle Cell Disease

Objective:�Todeterminewhetheraqualityimprove- ment�(QI)�initiativewouldresultinmoretimelyassess- mentandtreatmentofacutesicklecell-relatedpain� forpediatricpatientswithsicklecelldisease�(SCD)� treatedintheemergencydepartment�(ED).� •� Methods:�Wecreatedandimplementedaprotocolfor� SCDpainmanagementintheEDwiththegoalsof� improving�(1)�meantimefromtriagetofirstanalgesic� dose;�(2)�percentageofpatientsthatreceivedtheir� firstanalgesicdosewithin�30�minutesoftriage,�and� (3)�percentageofpatientswhohadpainassessment� performedwithin�30�minutesoftriageandwhowere� re-assessedwithin�30�minutesafterthefirstanalgesic� dose.� •� Results:� Significantimprovementswereachieved� betweenbaseline�(55�patientvisits)�andpostorder� setimplementation�(165�visits)�intimefromtriageto� administrationoffirstanalgesic�(decreasedfrom�89.9� ±�50.5�to�35.2�±�22.8�minutes,�P�<�0.001);�percentage� ofpatientvisitsreceivingpainmedicationswithin�30� minutesoftriage�(from�7%�to�53%,�P�<�0.001);�per- centageofpatientvisitsassessedwithin�30�minutes� oftriage�(from�64%�to�99.4%,�P <�0.001);�andpercent- ageofpatientvisitsre-assessedwithin�30�minutesof� initialanalgesic�(from�54%�to�86%,�P�<�0.001).� •� Conclusions:�ImplementationofaQIinitiativeinthe� EDledtoexpeditiouscareforpediatricpatientswith� SCDpresentingwithpain.�AQIframeworkprovided� uswithuniquechallengesbutalsoinvaluablelessons� asweaddressourobjectiveofdecreasingthequality� gapinSCDmedicalcare.