#35788 Acute pain protocol for sickle cell crisis – quality improvement project

Siyun Xie, Elizabeth Nguyen, Jameson Dowell, Esteban Esquivel, Moe Ameri, Melissa Victory Brodman, Adebukola Owolabi
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Abstract

Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Application for ESRA Abstract Prizes: I don’t wish to apply for the ESRA Prizes

Background and Aims

Pain from sickle cell crises can be challenging to manage when patients experience intractable pain with high opioid requirements. We aim to decrease average hourly pain score by 20% over first four days of admission and decrease average length of stay by 20% for sickle cell admissions to UTMB by implementing an acute pain protocol for hospitalists and the Acute Pain Service to standardize pain management.

Methods

Being devoid of patient identifiable information, this study is exempt from IRB review requirements as per UTMB policy. We conducted a cohort study with a retrospective review of a control group (18 inpatient sickle cell patients) and a protocol group (18 patients) with the acute pain protocol implemented.

Results

The protocol group’s average hourly pain score for day 1 (5.6/10), day 2 (3.7/10), day 3 (3.4/10) and day 4 (3.8/10) were lower compared to the control group for day 1 (6.2/10), day 2 (4.2/10), day 3 (5.2/10) and day 4 (5.6/10). Average hourly pain scores for days 1-4 were lower by 24% (difference averaged over 4 days) in protocol group vs control group. The protocol group’s average days of admission was lower (5.9) than the control group (7.5) with a 21% difference.

Conclusions

We achieved our aim with faster pain control and shorter hospital stays. Next steps include creating a protocol for emergency physicians for earlier pain control. Overall, protocol-based pain management facilitated faster pain control, leading to more effective medical management – an approach that can be applied to hospital-wide admissions involving pain.
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#35788急性疼痛方案镰状细胞危象-质量改进项目
申请ESRA摘要奖项:我不希望申请ESRA奖项背景和目的当患者经历高阿片类药物需求的难治性疼痛时,镰状细胞危像引起的疼痛可能具有挑战性。我们的目标是通过实施医院和急性疼痛服务的急性疼痛协议来标准化疼痛管理,将入院前四天的平均小时疼痛评分降低20%,并将镰状细胞入院的平均住院时间减少20%。方法由于缺乏患者身份信息,本研究根据UTMB政策免于IRB审查要求。我们进行了一项队列研究,对实施急性疼痛方案的对照组(18名住院镰状细胞患者)和方案组(18名患者)进行了回顾性评价。结果治疗组第1天(5.6/10)、第2天(3.7/10)、第3天(3.4/10)、第4天(3.8/10)的平均小时疼痛评分第1天(6.2/10)、第2天(4.2/10)、第3天(5.2/10)、第4天(5.6/10)均低于对照组。治疗组1-4天的平均每小时疼痛评分比对照组低24%(4天平均差异)。方案组的平均入院天数(5.9天)低于对照组(7.5天),差异为21%。结论本组患者疼痛控制快,住院时间短,达到治疗目的。接下来的步骤包括为急诊医生制定一个早期疼痛控制的协议。总体而言,基于方案的疼痛管理促进了更快的疼痛控制,从而导致更有效的医疗管理-一种可应用于涉及疼痛的全院入院的方法。
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