title: Quality improvement process in a sickle cell infusion center.
abstract: BACKGROUND
  The American Pain Society recommends that individuals experiencing sickle cell crisis receive parenteral pain medication within 30 minutes of assessment. We examined factors affecting achievement of this standard at the Johns Hopkins Sickle Cell Infusion Center.
  
  
  METHODS
  Baseline patient care time intervals and data on variables affecting the ability to achieve the American Pain Society goal were measured. Time to first parenteral opiate administration was modeled using simple and multivariable linear regression.
  
  
  RESULTS
  Mean time from initial assessment to first dose was initially 41 minutes. Increased nurse to patient ratio decreased time to first dose.
  
  
  CONCLUSIONS
  Of the factors associated with improved times to first dose, only nurse to patient ratio is amenable to process change, suggesting it as a potential target for future interventions.
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, Md. Electronic address: lwhitem1@jhmi.edu.
authors.forename: Lauren N
authors.initials: LN
authors.lastname: Whiteman
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, Md.
authors.forename: Sophie
authors.initials: S
authors.lastname: Lanzkron
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, Md; Department of Pediatrics, Johns Hopkins University, Baltimore, Md.
authors.forename: Rosalyn W
authors.initials: RW
authors.lastname: Stewart
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, Md; Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Md.
authors.forename: Carlton
authors.initials: C
authors.lastname: Haywood
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, Md; Department of Pediatrics, Johns Hopkins University, Baltimore, Md.
authors.forename: John J
authors.initials: JJ
authors.lastname: Strouse
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, Md; Department of Pediatrics, Johns Hopkins University, Baltimore, Md.
authors.forename: Leonard
authors.initials: L
authors.lastname: Feldman
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000755:Anemia, Sickle Cell / Q000628:therapy*; D005260:Female; D006801:Humans; D007263:Infusions, Parenteral; D008297:Male; D018710:Pain Clinics / Q000458:organization & administration / Q000592:standards*; D005791:Patient Care / Q000592:standards; D058996:Quality Improvement
chemical_list: D000701:Analgesics, Opioid
keywords: Acute care; Quality improvement; Sickle cell disease