Improving the Care of Individuals With Sickle Cell Disease in the Emergency Department Using a Quality Improvement Framework

Abstract

Sickle cell disease (SCD) is a severe chronic disease that leads to premature mortality caused by serious complications of the disease such as acute chest syndrome, stroke, and sepsis. Patients presenting to the emergency department (ED) with pain due to vaso-occlusive crisis (VOC) are at a higher risk for complications, making it imperative that emergency nurses, nurse practitioners, and physicians are knowledgeable about SCD and understand the other associated complications besides VOC. Because of the complexity of disease and misperceptions about SCD among ED nurses, physicians, and nurse practitioners, a quality improvement (QI) framework for treatment of adults with SCD in EDs was developed. The Emergency Department Sickle Cell Assessment of Needs and Strengths (ED-SCANS) is a research-based QI framework consisting of 7 distinct algorithms that serve to guide all ED team members in assessment and management of the complexity of care that patients with SCD require.

Emergency Department Utilization for Patients Living With Sickle Cell Disease: Psychosocial Predictors of Health Care Behaviors

“…8,10 Most studies also noted that SCD pain is the most dominant feature of ED presentation. 20,36 However, our study found that higher pain frequency was a significant predictor of having delayed ED care. Possible reasons for this can be considered in light of our other findings.…”

“…Other guidelines for SCD care in the ED exist. 1 , 20 , 43 From a policy and educational perspective, however, more work is needed to reduce these “educational gaps and biases among providers, staff, and patients [that] create barriers to communication and trust, and erode the provider-patient relationship.” 43 Building patient and ED provider communication will be fundamental to improving care for the SCD patient population in the United States, with the goal of improving quality of life and ultimately reducing morbidity and mortality.…”

“…The analytic frame for the study was developed out of a desire to understand contributors to the delay of needed ED care by individuals with SCD. Given Bediako and Harris's 19 assessment that the cultural and social factors for health care use are understudied for SCD individuals, and that stigma and prejudice in health care are unfortunate realities of living with SCD, 20,21 we chose to focus our analyses around survey measures related to stigma experiences, satisfaction with previous health care, and mental health and well-being (Beck Depression Index and Rosenberg Self-Esteem Scale). Additionally, previous literature has shown connections between delay of ED care in non-SCD contexts and clinical factors, demographic characteristics, and access to non-ED care (ie, whether patients have a primary physician).…”