title: Multi-modal intervention for the inpatient management of sickle cell pain significantly decreases the rate of acute chest syndrome.
abstract: BACKGROUND
  Pain in children with sickle cell disease (SCD) is the leading cause of acute care visits and hospitalizations. Pain episodes are a risk factor for the development of acute chest syndrome (ACS), contributing to morbidity and mortality in SCD. Few strategies exist to prevent this complication.
  
  
  METHODS
  We performed a before-and-after prospective multi-modal intervention. All children with SCD admitted for pain during the 2-year study period were eligible. The multi-modal intervention included standardized admission orders, monthly house staff education, and one-on-one patient and caregiver education.
  
  
  RESULTS
  A total of 332 admissions for pain occurred during the study period; 159 before the intervention and 173 during the intervention. The ACS rate declined by 50% during the intervention period 25% (39 of 159) to 12% (21 of 173); P = 0.003. Time to ACS development increased from 0.8 days (0.03-5.2) to 1.7 days (0.03-5.8); P = 0.047. No significant difference was found in patient demographics, intravenous fluid amount administered, frequency of normal saline bolus administration, or cumulative opioid amount delivered in the first 24 hr. Patient controlled analgesia-use was more common after the intervention 52% (82 of 159) versus 73% (126 of 173; P = 0.0001) and fewer patients required changes in analgesic dosing within the first 24 hr after admission (26%, 42 of 159 vs. 16%, 28 of 173; P = 0.015).
  
  
  CONCLUSIONS
  A multi-modal intervention to educate and subsequently change physician's behavior likely decreased the rate of ACS in the setting of a single teaching hospital.
authors.affiliation: Department of Genetics, Washington University School of Medicine, St Louis, Missouri, USA.
authors.forename: Mary M
authors.initials: MM
authors.lastname: Reagan
authors.forename: Michael R
authors.initials: MR
authors.lastname: DeBaun
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: Frei-Jones
mesh_terms: D056586:Acute Chest Syndrome / Q000209:etiology / Q000517:prevention & control*; D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000150:complications / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004503:Education, Medical, Graduate / Q000379:methods*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007297:Inpatients; D007396:Internship and Residency; D008297:Male; D010146:Pain / Q000209:etiology; D059408:Pain Management; D010353:Patient Education as Topic / Q000379:methods*; D055815:Young Adult