The Effect of Use of Individualized Pain Plans in Sickle Cell Patients Presenting to the Emergency Department

A comparison of the effect of patient‐specific versus weight‐based protocols to treat vaso‐occlusive episodes in the emergency department

“…Finally, many individuals with SCD report preferring to avoid hospital admission in favor of discharge from the ED if their pain is controlled sufficiently to be able to manage at home. While we found no difference between protocols with regard to hospital admission, our hospital admission rates are similar to other quality improvement projects that implemented PSPs in either adult or pediatric EDs, with admission rates ranging from 52% to 63% 19–22 . Our pilot RCT also had admission rates of 58% and 40% for patients randomized to WB and individualized pain protocols, respectively 5 .…”

“…ED physicians reported being satisfied with the clarity of the order (97.6%), its ability to manage pain (91%), and better than their usual ED strategy (70%) 23 . PSPs to treat VOC have been found to decrease time to administration of first opioid, overall time to disposition when guidelines are followed, and hospital admission rates 19,20,22,24,25 …”

“…improvement projects that implemented PSPs in either adult or pediatric EDs, with admission rates ranging from 52% to 63%. [19][20][21][22] Our pilot RCT also had admission rates of 58% and 40% for patients randomized to WB and individualized pain protocols, respectively. 5 Future investigations will help gain an understanding In our previous study and in the current project, EM providers had excellent adherence to the protocol.…”

Time to pain relief: A randomized controlled trial in the emergency department during vaso‐occlusive episodes in sickle cell disease

“…11 In one adult center, using a prepost design, individualized plans for 221 adults were developed and resulted in both a more rapid time to initial opioid and a shorter ED length of stay, but not a lower hospital admission rate. 12 Our findings take the next step to demonstrate that individual plans resulted in more rapid pain relief, and lower hospital admission rates. 3 In our sample, persons randomized to receive individualized relative to weight-based protocols not only experienced greater reductions in pain at discharge time, but they experienced pain relief sooner.…”

“…For every 10 min increase in time to first dose of pain medication, the relative risk of admission increased by 0.7% 11 . In one adult center, using a prepost design, individualized plans for 221 adults were developed and resulted in both a more rapid time to initial opioid and a shorter ED length of stay, but not a lower hospital admission rate 12 . Our findings take the next step to demonstrate that individual plans resulted in more rapid pain relief, and lower hospital admission rates 3 .…”