Developing an emergency department order set to treat acute pain in sickle cell disease

Yves Duroseau; David Beenhouwer; Michael S Broder; Bonnie Brown; Tartania Brown; Sarah N Gibbs; Kaedrea Jackson; Sally Liang; Melanie Malloy; Marie-Laure Romney; Dana Shani; Jena Simon; Irina Yermilov

doi:10.1002/emp2.12487

Developing an emergency department order set to treat acute pain in sickle cell disease

J Am Coll Emerg Physicians Open. 2021 Aug 7;2(4):e12487. doi: 10.1002/emp2.12487. eCollection 2021 Aug.

Authors

Affiliations

¹ Department of Emergency Medicine Lenox Hill Hospital/Northwell Health New York New York USA.
² Partnership for Health Analytic Research (PHAR) Beverly Hills California USA.
³ Observation Medicine Mount Sinai Morningside and West New York New York USA.
⁴ Metropolitan Jewish Healthcare System Department of Family and Social Medicine Albert Einstein College of Medicine Bronx New York USA.
⁵ Department of Emergency Medicine Mount Sinai Morningside New York New York USA.
⁶ Mount Sinai Beth Israel Emergency Medicine Icahn School of Medicine at Mount Sinai New York New York USA.
⁷ Emergency Medicine Mount Sinai Brooklyn Icahn School of Medicine at Mount Sinai Brooklyn New York USA.
⁸ Quality and Patient Safety Department of Emergency Medicine Columbia University New York New York USA.
⁹ Departments of Hematology, Medical Oncology and Internal Medicine Lenox Hill Hospital/Northwell Health New York New York USA.
¹⁰ Adult Program for Sickle Cell at Mount Sinai Hospital New York New York USA.

Abstract

Study objective: Patients with sickle cell disease (SCD) have many emergency department visits because of painful vaso-occlusive episodes (VOE). Guidelines recommend treatment within 30 minutes of triage, but this is rarely achieved in clinical practice. Our goal was to develop an order set that is being implemented in the ED to facilitate and standardize emergency care for SCD patients in acute pain from VOEs presenting to the emergency department (ED) in New York City (NYC).

Methods: Using a RAND/University of California, Los Angeles modified Delphi panel, we convened a multidisciplinary panel and reviewed evidence on how to best manage SCD pain in the ED. Panelists collaboratively developed then rated 202 items that could be included in an ED order set.

Results: A consensus order set, a practical how-to guide for managing SCD pain in the ED, was developed based on items that received high median ratings.

Conclusions: The management of acute pain experienced during VOEs is critical to patients with SCD; ED order sets, such as this one, can help standardize pain management, including at triage, evaluation, discharge, and follow-up care. After implementation in NYC EDs, studies to examine changes in quality care metrics (eg, wait times, readmissions) are planned.

Keywords: acute pain; analgesics; anemia; emergency medicine; emergency service; hospital; opioid; practice guideline; quality of health care; sickle cell.