TY - JOUR
T1 - Outcomes of an Emergency Department Observation Unit–Based Pathway for the Treatment of Uncomplicated Vaso-occlusive Events in Sickle Cell Disease
AU - Lyon, Matthew
AU - Sturgis, Lashon
AU - Lottenberg, Richard
AU - Gibson, Marin E.
AU - Eck, Jonathan
AU - Kutlar, Abdullah
AU - Gibson, Robert W.
N1 - Funding Information:
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). This project was supported by funding from the National Center on MInority Health and Health Disparities for the Southeaster Exploratory Sickle Cell Center of Excellence (P20 MD003383-01). Publication of this supplement was supported by the Office of Minority Health of the US Department of Health and Human Services.
Funding Information:
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org ). This project was supported by funding from the National Center on MInority Health and Health Disparities for the Southeaster Exploratory Sickle Cell Center of Excellence ( P20 MD003383-01 ). Publication of this supplement was supported by the Office of Minority Health of the US Department of Health and Human Services.
Publisher Copyright:
© 2020 American College of Emergency Physicians
PY - 2020/9
Y1 - 2020/9
N2 - Study objective: This was a prospective, pre-post, 13-year observational study documenting the multiyear implementation of an observation unit sickle cell pathway for patients with uncomplicated vaso-occlusive events. Methods: The sickle cell pathway begins with rapid triage to identify patients with uncomplicated vaso-occlusive events for immediate transfer to the observation unit and initiation of patient-controlled analgesia followed by repeated evaluations of pain and identification of other complications. Data were abstracted from the electronic medical record or observation unit database. The sickle cell pathway was initiated in April 2006. Major revisions of it were carried out in June 2009 (physician evaluation occurs in sickle cell pathway and only patient-controlled analgesia administration of medications) and October 2010 (multidisciplinary management and individual dosing). Results: Annual ED visits ranged between 287 and 528. The preimplementation hospital admission rate was 33% (123/368), 3-day return rate 16% (60/368), and 30-day return rate 67% (248/368). Refinements to the sickle cell pathway have resulted in a decrease in admission rate to 20% (258/1276); 3-day return rate, to 3.6% (46/1,276); and 30-day return rate, to 41% (525/1,276) for the past 3 years. Conclusion: The use of a sickle cell pathway for the treatment of uncomplicated vaso-occlusive events has been effective in providing rapid treatment and reducing hospital admissions. However, it was not only the intervention and its refinement that made the sickle cell pathway successful. With the Consolidated Framework for Implementation Research, it was discerned that outer setting factors of organizational commitment to the care of patients with SCD, inner setting factors of learning climate and leadership engagement, individuals, and process contributed to the success of the sickle cell pathway.
AB - Study objective: This was a prospective, pre-post, 13-year observational study documenting the multiyear implementation of an observation unit sickle cell pathway for patients with uncomplicated vaso-occlusive events. Methods: The sickle cell pathway begins with rapid triage to identify patients with uncomplicated vaso-occlusive events for immediate transfer to the observation unit and initiation of patient-controlled analgesia followed by repeated evaluations of pain and identification of other complications. Data were abstracted from the electronic medical record or observation unit database. The sickle cell pathway was initiated in April 2006. Major revisions of it were carried out in June 2009 (physician evaluation occurs in sickle cell pathway and only patient-controlled analgesia administration of medications) and October 2010 (multidisciplinary management and individual dosing). Results: Annual ED visits ranged between 287 and 528. The preimplementation hospital admission rate was 33% (123/368), 3-day return rate 16% (60/368), and 30-day return rate 67% (248/368). Refinements to the sickle cell pathway have resulted in a decrease in admission rate to 20% (258/1276); 3-day return rate, to 3.6% (46/1,276); and 30-day return rate, to 41% (525/1,276) for the past 3 years. Conclusion: The use of a sickle cell pathway for the treatment of uncomplicated vaso-occlusive events has been effective in providing rapid treatment and reducing hospital admissions. However, it was not only the intervention and its refinement that made the sickle cell pathway successful. With the Consolidated Framework for Implementation Research, it was discerned that outer setting factors of organizational commitment to the care of patients with SCD, inner setting factors of learning climate and leadership engagement, individuals, and process contributed to the success of the sickle cell pathway.
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U2 - 10.1016/j.annemergmed.2020.08.007
DO - 10.1016/j.annemergmed.2020.08.007
M3 - Article
C2 - 32928457
AN - SCOPUS:85090578234
SN - 0196-0644
VL - 76
SP - S12-S20
JO - Annals of emergency medicine
JF - Annals of emergency medicine
IS - 3
ER -