title: A Quality Improvement Initiative to Improve Emergency Department Care for Pediatric Patients with Sickle Cell Disease.
abstract: OBJECTIVE
  To determine whether a quality improvement (QI) initiative would result in more timely assessment and treatment of acute sickle cell-related pain for pediatric patients with sickle cell disease (SCD) treated in the emergency department (ED).
  
  
  METHODS
  We created and implemented a protocol for SCD pain management in the ED with the goals of improving (1) mean time from triage to first analgesic dose; (2) percentage of patients that received their first analgesic dose within 30 minutes of triage, and (3) percentage of patients who had pain assessment performed within 30 minutes of triage and who were re-assessed within 30 minutes after the first analgesic dose.
  
  
  RESULTS
  Significant improvements were achieved between baseline (55 patient visits) and post order set implementation (165 visits) in time from triage to administration of first analgesic (decreased from 89.9 ± 50.5 to 35.2 ± 22.8 minutes,P< 0.001); percentage of patient visits receiving pain medications within 30 minutes of triage (from 7% to 53%,P< 0.001); percentage of patient visits assessed within 30 minutes of triage (from 64% to 99.4%,P< 0.001); and percentage of patient visits re-assessed within 30 minutes of initial analgesic (from 54% to 86%,P< 0.001).
  
  
  CONCLUSIONS
  Implementation of a QI initiative in the ED led to expeditious care for pediatric patients with SCD presenting with pain. A QI framework provided us with unique challenges but also invaluable lessons as we address our objective of decreasing the quality gap in SCD medical care.
authors.affiliation: Children's Hospital & Research Center Oakland, Oakland, CA.
authors.forename: Marsha J
authors.initials: MJ
authors.lastname: Treadwell
authors.affiliation: Children's Hospital & Research Center Oakland, Oakland, CA.
authors.forename: Michael
authors.initials: M
authors.lastname: Bell
authors.affiliation: Children's Hospital & Research Center Oakland, Oakland, CA.
authors.forename: Sara A
authors.initials: SA
authors.lastname: Leibovich
authors.affiliation: Children's Hospital & Research Center Oakland, Oakland, CA.
authors.forename: Fernando
authors.initials: F
authors.lastname: Barreda
authors.affiliation: Children's Hospital & Research Center Oakland, Oakland, CA.
authors.forename: Anne
authors.initials: A
authors.lastname: Marsh
authors.affiliation: Children's Hospital & Research Center Oakland, Oakland, CA.
authors.forename: Ginny
authors.initials: G
authors.lastname: Gildengorin
authors.affiliation: Children's Hospital & Research Center Oakland, Oakland, CA.
authors.forename: Claudia R
authors.initials: CR
authors.lastname: Morris