title: Patient-controlled analgesia for sickle cell pain crisis in a pediatric emergency department.
abstract: OBJECTIVE
  To determine whether a protocol to start patient-controlled analgesia (PCA) in the emergency department (ED-PCA) would shorten the length of time between narcotic bolus doses and PCA initiation as compared with standard inpatient initiation of PCA (IP-PCA). Also, to compare patient satisfaction and inpatient length of stay for the 2 groups.
  
  
  METHODS
  To improve care, we developed a protocol to institute ED-PCA after an initial bolus dose of narcotics. This was a nonrandomized pilot study. Patient records were reviewed for location of PCA initiation, time from narcotic bolus to initiation of PCA, and length of stay. A brief patient/parent satisfaction survey was collected.
  
  
  RESULTS
  Sixty-nine records were reviewed. Patients treated using the protocol had initiation of PCA therapy within 35 +/- 7 minutes from the last bolus narcotic dose in the emergency department versus 211 +/- 17 minutes for nonprotocol patients. Forty-eight of 50 patient surveys indicated preference for starting ED-PCA; 2 did not have a preference. No complications were identified in either group.
  
  
  CONCLUSIONS
  A protocol to initiate PCA for sickle cell patients in a pediatric emergency department shortened the time of its initiation and was preferred by patients.
authors.affiliation: Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, WI 53226, USA. mmelzer@mail.mcw.edu
authors.forename: Marlene D
authors.initials: MD
authors.lastname: Melzer-Lange
authors.forename: Christine M
authors.initials: CM
authors.lastname: Walsh-Kelly
authors.forename: Gwen
authors.initials: G
authors.lastname: Lea
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Hillery
authors.forename: J Paul
authors.initials: JP
authors.lastname: Scott
mesh_terms: D000293:Adolescent; D016058:Analgesia, Patient-Controlled / Q000706:statistics & numerical data*; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000627:therapeutic use; D000755:Anemia, Sickle Cell / Q000150:complications*; D001157:Arterial Occlusive Diseases / Q000209:etiology; D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D002985:Clinical Protocols; D004334:Drug Administration Schedule; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D017050:Episode of Care; D006801:Humans; D007297:Inpatients / Q000523:psychology; D007902:Length of Stay; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D017060:Patient Satisfaction; D010865:Pilot Projects
chemical_list: D000701:Analgesics, Opioid