LAUSR

INTRODUCTION Pain associated with sickle cell disease (SCD) causes severe complications and frequent presentation to the emergency department (ED). Patients with SCD frequently report inadequate pain treatment in the ED resulting in hospital admission. A retrospective analysis was conducted to assess a quality improvement (QI) project to standardized ED care for SCD patients presenting with pain associated SCD. METHODS A 3-year prospective QI initiative was performed. Our multi-disciplinary team of providers implemented an ED Order Set in 2019 to improve care and provide adequate analgesia management. Our primary outcome was the overall hospital admission rate for patients' post-intervention. Secondary outcomes measures included ED disposition, 72-hour return to ED rate, ED pain scores at admission and discharge, ED treatment time, in-patient length of stay, non-opioid medication usages, and opioid medication usages. RESULTS There was an overall 67% reduction in the hospital admission rate following implementation of the order set (p = 0.005) and a significant decrease in percentage admission rate over month (p = 0.047). Time to first non-opioid analgesic decreased by 71 minutes (p > 0.001) and there was no change in time to first opioid medication. The 72-hour return to the ED remain unchanged (7.0% vs 7.1%) (p = 0.93) and ED elopement rate remained unchanged (1.3% vs 1.85) (p = 0.93). Following the implementation, significant increases in prescribing of orally administered acetaminophen (7%), celecoxib (1.2%), tizanidine (12.5%), and intravenous ketamine (30.5%), and ketorolac (27%). ED pain scores at discharge were unchanged for both hospital-admitted (7.12 vs 7.08 p = 0.93) and non-admitted (5.51 vs 6.11, p = 0.27) patients. Potential resulting cost reduction was determined to be $193,440 during the 12-month observation period with mean cost per visit decreasing by $792. CONCLUSIONS Utilization of a standardized and multimodal ED order set reduced hospital admission rates and the timeliness of analgesia without negatively impacting patients' pain.