1. A QI Project to Improve Pain Management in Sickle Cell Vaso-Occlusive Crisis Dana LeBlanc, MD, Renee Gardner, MD, Maria Velez, MD, Cori Morrison, MD Pediatric Hematology/Oncology and Hematopoietic Stem Cell Transplant LSUHSC/Children’s Hospital of New Orleans

2. Background Sickle Cell Disease (SCD) affects 70,000 -100,000 Americans 2,000 infants are born with SCD each year Pain due to vaso-occlusive crises (VOC) is a leading cause of hospital admission and healthcare cost in pediatric patients with SCD National Hospital Ambulatory Medical Care Survey 1999-2007: ~200,000 ED visits/yr for SCD 78% of visits were for pain 17% of patients 0-19 yrs of age

3. Background Lack of consistent healthcare provider education regarding management of these patients often results in delayed or inadequate analgesic administration Prolongs hospital stays Leads to patient distrust and dissatisfaction with the medical team

4. Pathogenesis Nucleotide substitution in the beta globin gene (glutamic acid to valine) allows hemoglobin S polymerize in deoxygenated states

5. Treatment of VOC IV hydration Parenteral opioid administration Morphine or Dilaudid Patient controlled analgesia (PCA) or on demand boluses Adjuvant therapies NSAIDs Tricyclic antidepressants

6. Objectives To evaluate and improve physician education, attitudes and comfort level regarding management of SCD VOC To improve the timeliness of achieving adequate pain control during a VOC To reduce hospital stay duration, reduce readmission rates, and improve patient satisfaction with VOC management Ultimately, to improve the overall quality of life of our sickle cell patients

7. Study Design 3 parts: Physician Education and Surveys Patient Surveys Inpatient Data Analysis

8. Physician Education & Surveys Educational modules Grand rounds presentation Interactive pain management workshop as part of the intern lecture series Video recorded “refresher” prior to starting Hematology service month Materials Preprinted VOC order forms Pocket cards with pain management guidelines Pre and post education surveys Assess resident knowledge and understanding of VOC management Assess resident attitudes regarding SCD patients and VOC

9. Preprinted Orders for VOC

10. Study Tools

11. Patient Surveys Will survey patients both prior to and after initiation of physician education Will assess: Patient satisfaction with medical care received Confidence in the medical staff Patient perception of pain management Preferred medications Promptness of administration Physician attitudes Patients to be surveyed at routine clinic visits

12. Inpatient Data Analysis Retrospective chart review of SCD patients admitted for pain crises Data to be collected: Number of hospital days Time until optimal pain control is achieved Method of narcotic administration and maximum dose required Adjuvant therapies Readmission rates Pre and post survey data will be analyzed

13. Anticipated Results More consistent pain management Improved physician education Standardized pain management orders Pain management guidelines Faster resolution of VOC Adequate pain control achieved more quickly Shorter hospital stays with fewer readmissions Greater patient satisfaction Improved trust and confidence in the medical staff Less time spent hospitalized Improved quality of life

14. Questions?