Patient-controlled analgesia for sickle cell pain crisis in a pediatric emergency department.
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.
Melzer-Lange
Marlene D
MD
Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, WI 53226, USA. mmelzer@mail.mcw.edu
Walsh-Kelly
Christine M
CM
Lea
Gwen
G
Hillery
Cheryl A
CA
Scott
J Paul
JP
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
D000701:Analgesics, Opioid