Chart Card: Feasibility of a Tool for Improving Emergency Department Care in Sickle Cell Disease

Abstract

Background Patients with sickle cell disease (SCD) are concerned with emergency department care, including time to treatment and staff attitudes and knowledge. Providers are concerned about rapid access to patient information and SCD treatment protocols. A software application that stores and retrieves encrypted personal medical information on a plastic credit card–sized Chart Card was designed. Objective To determine the applicability and feasibility of the Chart Card on patient satisfaction with emergency department care and provider accessibility to patient information and care protocols. Methods One-half of 44 adults (aged ~18 years) and 50 children with SCD were randomized to either the Chart Card or usual care. Patient satisfaction was surveyed pre and post implementation of the Chart Card program, and emergency department staff was surveyed about familiarity with SCD treatment protocols. Results Fifty-two percent of patients were female (mean age, 18.8 ± 15.6); 61% had SCD SS. Adults visited an emergency department 4.2 ± 4.0 times in the year prior to enrollment vs 2.7 ± 3.7 (p = .06) visits for children, most commonly for pain. Patient emergency department care ratings of very good or excellent increased from 47% to 66% (p < .05), and ratings of staff knowledge improved. Qualitative data reflected positive comments about patient and staff experiences with the Chart Card. Conclusion Patient satisfaction with emergency department care and efficacy in health care increased post Chart Card implementation. Providers valued immediate access to patient information and SCD treatment guidelines. The technology has potential for application in the treatment of other illnesses in other settings.

Experiences of Pediatric Patients With Sickle Cell Disease in Rural Emergency Departments

“…Results of the study indicated that a large percentage (41%) of children with SCD visited the ED in a 6 month period, with at least a quarter of those visiting three or more times during that period. Consistent with research using children from urban settings, [1,2] a majority (77.78%) of the guardians of the current sample reported being satisfied with the ED care their child received. However, in contrast to only 9% of parents and children indicating dissatisfaction with experiences at urban EDs, [1,2] 22.22% of the current sample of parents indicated they were dissatisfied with their child’s ED experience.…”

“…Consistent with research using children from urban settings, [1,2] a majority (77.78%) of the guardians of the current sample reported being satisfied with the ED care their child received. However, in contrast to only 9% of parents and children indicating dissatisfaction with experiences at urban EDs, [1,2] 22.22% of the current sample of parents indicated they were dissatisfied with their child’s ED experience. Approximately 25% of the current sample indicated that HCPs did not spend enough time with them and that their children did not receive speedy care.…”

“…[1,2] However, there are few studies examining patient satisfaction with ED care in the pediatric SCD population. Patient satisfaction has been identified as an important patient centered outcome by the Centers for Medicare and Medicaid Services, the National Committee on Quality Assurance [3] and the Affordable Care Act.…”

“…A study of 50 pediatric patients with SCD and 44 adults with SCD found that 63% of the pediatric patients rated their ED experience as excellent or very good in contrast to only 33% of the adult SCD sample. [2] In addition, 28% of the pediatric sample rated the experience as good, 7% rated it as fair, and 2% rated it as poor. Fifty-nine percent of the pediatric sample rated their physician’s knowledge of SCD as excellent or very good, and when asked what would improve treatment at the ED, the majority of responses focused on the need for more swift care.…”

“…Fifty-nine percent of the pediatric sample rated their physician’s knowledge of SCD as excellent or very good, and when asked what would improve treatment at the ED, the majority of responses focused on the need for more swift care. [2] …”