title: Patient Controlled Analgesia for Adults with Sickle Cell Disease Awaiting Admission from the Emergency Department.
abstract: Background. A treatment algorithm for sickle cell disease (SCD) pain in adults presenting to a single emergency department (ED) was developed prioritizing initiation of patient controlled analgesia (PCA) for patients awaiting hospitalization. Objectives. Evaluate the proportion of ED visits in which PCA was started in the ED. Methods. A two-year retrospective chart review of consecutive SCD pain ED visits was undertaken. Data abstracted included PCA initiation, low versus high utilizer status, pain scores, bolus opioid number, treatment times, and length of hospitalization. Results. 258 visits resulted in hospitalization. PCA was initiated in 230 (89%) visits of which 157 (68%) were initiated in the ED. Time to PCA initiation was longer when PCA was begun after hospitalization versus in the ED (8.6 versus 4.5 hours, p < 0.001). ED PCA initiation was associated with fewer opioid boluses following decision to admit and less time without analgesic treatment (all p < 0.05). Mean pain intensity (MPI) reduction did not differ between groups. Among visits where PCA was begun in the ED, low utilizers demonstrated greater MPI reduction than high utilizers (2.8 versus 2.0, p = 0.04). Conclusions. ED PCA initiation for SCD-related pain is possible and associated with more timely analgesic delivery.
authors.affiliation: New England Sickle Cell Institute, Division of Hematology-Oncology, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, USA.
authors.forename: Josue
authors.initials: J
authors.lastname: Santos
authors.affiliation: New England Sickle Cell Institute, Division of Hematology-Oncology, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, USA.
authors.forename: Sasia
authors.initials: S
authors.lastname: Jones
authors.affiliation: Connecticut Institute for Clinical and Translational Science, 263 Farmington Avenue, Farmington, CT 06030, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Wakefield
authors.affiliation: Connecticut Institute for Clinical and Translational Science, 263 Farmington Avenue, Farmington, CT 06030, USA; Department of Community Medicine and Health Care, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, USA.
authors.forename: James
authors.initials: J
authors.lastname: Grady
authors.affiliation: New England Sickle Cell Institute, Division of Hematology-Oncology, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, USA.
authors.forename: Biree
authors.initials: B
authors.lastname: Andemariam
mesh_terms: D000328:Adult; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000755:Anemia, Sickle Cell / Q000150:complications*; D057286:Electronic Health Records / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D017063:Outcome Assessment, Health Care; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D012189:Retrospective Studies; D055815:Young Adult