The management of acute vasoocclusive crisis remains a challenge. Long Island Jewish Medical Center is a 500adult bed tertiary care facility with more than 500 reported admissions for acute vasoocclusive crisis in 2009. Suboptimal pain management in the Emergency Department (ED) frequently resulted in unrelieved pain, recurrent admissions, prolonged hospitalization, and increased patient dissatisfaction.
An interdisciplinary team that included a patient with SCD was assembled to meet weekly to address the above issues. Over six 6 months, the team was educated in Clinical Microsystems methods as described by Nelson et al. The team established a specific aim to achieve a sustained twopoint reduction in subjective pain scores within two 2 hours of inpatient admission.
Preliminary data using pain diaries and patient interviews was collected to assess performance with respect to pain management in admitted adult SCD patients. This interdisciplinary team noted whether a standardized order set was utilized and analyzed the admission process, noting significant delays from time of admission to the time that sufficient sustained analgesia was achieved. The PDSA cycle method to test and study change was utilized. Multiple interventions were simultaneously tested. First, given the high number of admissions from our ED for this patient population, we initiated proactive bed designation upon initial patient presentation to the ED. Second, we arranged for expedited transfer of patients admitted with vasoocclusive crisis to medical floors. Third, we educated house staff and nursing departments on providing appropriately dosed narcotic medication upon admission after pharmacy verification of previous patient specific dose requirements. Fourth, we encouraged the use of standardized order sets for vasoocclusive crisis admissions. Lastly, we arranged for storage of patient controlled analgesia (PCA) pumps on medical units designated for SCD patients, and if patients did not have a primary attending on staff, they were admitted to the hospitalist service. Hospitalists had received training in writing PCA orders, and as we cohorted SCD patients onto specific medical units, we sought to facilitate immediate initiation of pain via this modality. Timing of analgesic response was assessed based on patient interviews and the above patients’ pain diaries.
Prior to intervention, the median time to achieve a sustained reduction in pain by two points for patients admitted with sickle cell vasoocclusive crisis was nearly 48 hours. Post intervention, the team’s efforts reduced the median time to a sustained twopoint reduction in subjective pain to 26 hours and 20 minutes. The Clinical Microsystems Methodology is an effective means of engaging an interdisciplinary team in improving the time to analgesia in sickle cell patients admitted with acute vasoocclusive crisis.
To cite this abstract:Barnett B, Marcus D, Jaffrey F, Aghalar J, Ouchi K, Cascetta K, Roy R, Cohen R, Tan V. Application of Clinical Microsystems to Improve Pain Relief in Sickle Cell Disease (Scd) Patients Admitted with Acute Vasoocclusive Crisis. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97719. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/application-of-clinical-microsystems-to-improve-pain-relief-in-sickle-cell-disease-scd-patients-admitted-with-acute-vasoocclusive-crisis/. Accessed August 23, 2019.