David C Brousseau1, Elizabeth R Alpern2, James M Chamberlain3, Angela M Ellison4, Lalit Bajaj5, Daniel M Cohen6, Selena Hariharan7, Lawrence J Cook8, Monica Harding8, Julie Panepinto9. 1. Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI. Electronic address: dbrousse@mcw.edu. 2. Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL. 3. Emergency Medicine, Children's National Hospital, Washington, DC. 4. Department of Pediatrics/Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA. 5. Department of Pediatrics, University of Colorado, Denver, CO. 6. Nationwide Children's, Columbus, OH. 7. Cincinnati Children's Hospital and the Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH. 8. Department of Pediatrics, University of Utah, Salt Lake City, UT. 9. Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.
Abstract
STUDY OBJECTIVE: The National Heart, Lung, and Blood Institute evidence-based guidelines for timeliness of opioid administration for sickle cell disease (SCD) pain crises recommend an initial opioid within 1 hour of arrival, with subsequent dosing every 30 minutes until pain is controlled. No multisite studies have evaluated guideline adherence, to our knowledge. Our objective was to determine guideline adherence across a multicenter network. METHODS: We conducted a multiyear cross-sectional analysis of children with SCD who presented between January 1, 2016, and December 31, 2018, to 7 emergency departments (EDs) within the Pediatric Emergency Care Applied Research Network. Visits for uncomplicated pain crisis were included, defined with an International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10 code for SCD crisis and receipt of an opioid, excluding visits with other SCD complications or temperature exceeding 38.5°C (101.3°F). Times were extracted from the electronic record. Guideline adherence was assessed across sites and calendar years. RESULTS: A total of 4,578 visits were included. The median time to first opioid receipt was 62 minutes (interquartile range 42 to 93 minutes); between the first and second opioid receipt, 60 minutes (interquartile range 39 to 93 minutes). Overall, 48% of visits (95% confidence interval 47% to 50%) were guideline adherent for first opioid. Of 3,538 visits with a second opioid, 15% (95% confidence interval 14% to 16%) were guideline adherent. Site variation in adherence existed for time to first opioid (range 22% to 70%) and time between first and second opioid (range 2% to 36%; both P<.001). There was no change in timeliness to first dose or time between doses across years (P>.05 for both). CONCLUSION: Guideline adherence for timeliness of SCD treatment is poor, with half of visits adherent for time to first opioid and one seventh adherent for second dose. Dissemination and implementation research/quality improvement efforts are critical to improve care across EDs.
STUDY OBJECTIVE: The National Heart, Lung, and Blood Institute evidence-based guidelines for timeliness of opioid administration for sickle cell disease (SCD) pain crises recommend an initial opioid within 1 hour of arrival, with subsequent dosing every 30 minutes until pain is controlled. No multisite studies have evaluated guideline adherence, to our knowledge. Our objective was to determine guideline adherence across a multicenter network. METHODS: We conducted a multiyear cross-sectional analysis of children with SCD who presented between January 1, 2016, and December 31, 2018, to 7 emergency departments (EDs) within the Pediatric Emergency Care Applied Research Network. Visits for uncomplicated pain crisis were included, defined with an International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10 code for SCD crisis and receipt of an opioid, excluding visits with other SCD complications or temperature exceeding 38.5°C (101.3°F). Times were extracted from the electronic record. Guideline adherence was assessed across sites and calendar years. RESULTS: A total of 4,578 visits were included. The median time to first opioid receipt was 62 minutes (interquartile range 42 to 93 minutes); between the first and second opioid receipt, 60 minutes (interquartile range 39 to 93 minutes). Overall, 48% of visits (95% confidence interval 47% to 50%) were guideline adherent for first opioid. Of 3,538 visits with a second opioid, 15% (95% confidence interval 14% to 16%) were guideline adherent. Site variation in adherence existed for time to first opioid (range 22% to 70%) and time between first and second opioid (range 2% to 36%; both P<.001). There was no change in timeliness to first dose or time between doses across years (P>.05 for both). CONCLUSION: Guideline adherence for timeliness of SCD treatment is poor, with half of visits adherent for time to first opioid and one seventh adherent for second dose. Dissemination and implementation research/quality improvement efforts are critical to improve care across EDs.
Authors: Sara J Deakyne Davies; Robert W Grundmeier; Diego A Campos; Katie L Hayes; Jamie Bell; Evaline A Alessandrini; Lalit Bajaj; James M Chamberlain; Marc H Gorelick; Rene Enriquez; T Charles Casper; Beth Scheid; Marlena Kittick; J Michael Dean; Elizabeth R Alpern Journal: Appl Clin Inform Date: 2018-05-23 Impact factor: 2.342
Authors: Chris A Rees; David C Brousseau; Fahd A Ahmad; Jonathan Bennett; Seema Bhatt; Amanda Bogie; Kathleen M Brown; T Charles Casper; Laura L Chapman; Corrie E Chumpitazi; Daniel M Cohen; Carlton Dampier; Angela M Ellison; Hartmut Grasemann; Robert W Hickey; Lewis L Hsu; Peter A Lane; Nitya Bakshi; Sara Leibovich; Prabhumallikarjun Patil; Elizabeth C Powell; Rachel Richards; Syana Sarnaik; Debra L Weiner; Claudia R Morris Journal: Am J Hematol Date: 2022-09-05 Impact factor: 13.265