Robert E Molokie1, Chariz Montminy2, Corissa Dionisio3, Muhammad Ahmen Farooqui4, Michel Gowhari5, Yingwei Yao6, Marie L Suarez7, Miriam O Ezenwa8, Judith M Schlaeger9, Zaijie J Wang10, Diana J Wilkie11. 1. University of Illinois at Chicago, College of Medicine, Department of Hematology/Oncology, 820 S. Wood Street Suite 172 CSN (M/C 712), Chicago, IL 60612, United States; Jesse Brown Veterans Administration Medical Center, 820 S. Damen Avenue, MP 111, Chicago, IL 60612, United States; University of Illinois at Chicago, College of Pharmacy, Department of Biopharmaceutical Sciences, 833 S. Wood Street, Chicago, IL 60612, United States. Electronic address: remolokie@uic.edu. 2. University of Illinois Hospital and Health Sciences System, Department of Nursing, 1740 W. Taylor, Chicago, IL 60614, United States. Electronic address: ccalip2@uic.edu. 3. Riley Hospital for Children at Indiana University Health Department of Psychiatry, 705 Riley Hospital Drive, Indianapolis, IN 46202, United States. Electronic address: coridion@iu.edu. 4. Saint George's University, University Centre, Grenada. 5. University of Illinois at Chicago, College of Medicine, Department of Hematology/Oncology, 820 S. Wood Street Suite 172 CSN (M/C 712), Chicago, IL 60612, United States. Electronic address: mgowhal@uic.edu. 6. University of Illinois at Chicago, College of Nursing, Department of Biobehavioral Health Science, 845 S. Damen Avenue, (M/C 802), Chicago, IL 60612, United States; University of Florida, College of Nursing, Department of Biobehavioral Nursing Science, 1225 Center Drive, Room 2203, Gainesville, FL 32610, United States. Electronic address: yyao@uic.edu. 7. University of Illinois at Chicago, College of Nursing, Department of Biobehavioral Health Science, 845 S. Damen Avenue, (M/C 802), Chicago, IL 60612, United States. Electronic address: mlsuarez@uic.edu. 8. University of Illinois at Chicago, College of Nursing, Department of Biobehavioral Health Science, 845 S. Damen Avenue, (M/C 802), Chicago, IL 60612, United States; University of Florida, College of Nursing, Department of Biobehavioral Nursing Science, 1225 Center Drive, Room 2203, Gainesville, FL 32610, United States. Electronic address: moezenwa@uic.edu. 9. University of Illinois at Chicago, College of Nursing, Department of Women, Children and Family Health Science, 845 S. Damen Avenue, (M/C 802), Chicago, IL 60612, United States. Electronic address: jschlaeg@uic.edu. 10. University of Illinois at Chicago, College of Pharmacy, Department of Biopharmaceutical Sciences, 833 S. Wood Street, Chicago, IL 60612, United States. Electronic address: zjwang@uic.edu. 11. University of Illinois at Chicago, College of Nursing, Department of Biobehavioral Health Science, 845 S. Damen Avenue, (M/C 802), Chicago, IL 60612, United States; University of Florida, College of Nursing, Department of Biobehavioral Nursing Science, 1225 Center Drive, Room 2203, Gainesville, FL 32610, United States. Electronic address: diwilkie@uic.edu.
Abstract
BACKGROUND: Acute care units (ACUs) with focused sickle cell disease (SCD) care have been shown to effectively address pain and limit hospitalizations compared to emergency departments (ED), the reason for differences in admission rates is understudied. Our aim was compare effects of usual care for adult SCD pain in ACU and ED on opioid doses and discharge pain ratings, hospital admission rates and lengths of stay. METHODS: In a retrospective, comparative cohort, single academic tertiary center study, 148 adults with sickle cell pain received care in the ED, ACU or both. From the medical records we documented opioid doses, unit discharge pain ratings, hospital admission rates, and lengths of stay. FINDINGS: Pain on admission to the ED averaged 8.7±1.5 and to the ACU averaged 8.0±1.6. The average pain on discharge from the ED was 6.4±3.0 and for the ACU was 4.5±2.5. 70% of the 144 ED visits resulted in hospital admissions as compared to 37% of the 73 ACU visits. Admissions from the ED or ACU had similar inpatient lengths of stay. Significant differences between ED and ACU in first opioid dose and hourly opioid dose were noted. CONCLUSIONS: Applying guidelines for higher dosing of opioids for acute painful episodes in adults with SCD in ACU was associated with improved pain outcomes and decreased hospitalizations, compared to ED. Adoption of this approach for SCD pain in ED may result in improved outcomes, including a decrease in hospital admissions. Published by Elsevier Inc.
BACKGROUND: Acute care units (ACUs) with focused sickle cell disease (SCD) care have been shown to effectively address pain and limit hospitalizations compared to emergency departments (ED), the reason for differences in admission rates is understudied. Our aim was compare effects of usual care for adult SCD pain in ACU and ED on opioid doses and discharge pain ratings, hospital admission rates and lengths of stay. METHODS: In a retrospective, comparative cohort, single academic tertiary center study, 148 adults with sickle cell pain received care in the ED, ACU or both. From the medical records we documented opioid doses, unit discharge pain ratings, hospital admission rates, and lengths of stay. FINDINGS:Pain on admission to the ED averaged 8.7±1.5 and to the ACU averaged 8.0±1.6. The average pain on discharge from the ED was 6.4±3.0 and for the ACU was 4.5±2.5. 70% of the 144 ED visits resulted in hospital admissions as compared to 37% of the 73 ACU visits. Admissions from the ED or ACU had similar inpatient lengths of stay. Significant differences between ED and ACU in first opioid dose and hourly opioid dose were noted. CONCLUSIONS: Applying guidelines for higher dosing of opioids for acute painful episodes in adults with SCD in ACU was associated with improved pain outcomes and decreased hospitalizations, compared to ED. Adoption of this approach for SCD pain in ED may result in improved outcomes, including a decrease in hospital admissions. Published by Elsevier Inc.
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