#35788 Acute pain protocol for sickle cell crisis – quality improvement project

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Background and Aims

Pain from sickle cell crises can be challenging to manage when patients experience intractable pain with high opioid requirements. We aim to decrease average hourly pain score by 20% over first four days of admission and decrease average length of stay by 20% for sickle cell admissions to UTMB by implementing an acute pain protocol for hospitalists and the Acute Pain Service to standardize pain management.

Methods

Being devoid of patient identifiable information, this study is exempt from IRB review requirements as per UTMB policy. We conducted a cohort study with a retrospective review of a control group (18 inpatient sickle cell patients) and a protocol group (18 patients) with the acute pain protocol implemented.

Results

The protocol group’s average hourly pain score for day 1 (5.6/10), day 2 (3.7/10), day 3 (3.4/10) and day 4 (3.8/10) were lower compared to the control group for day 1 (6.2/10), day 2 (4.2/10), day 3 (5.2/10) and day 4 (5.6/10). Average hourly pain scores for days 1-4 were lower by 24% (difference averaged over 4 days) in protocol group vs control group. The protocol group’s average days of admission was lower (5.9) than the control group (7.5) with a 21% difference.

Conclusions

We achieved our aim with faster pain control and shorter hospital stays. Next steps include creating a protocol for emergency physicians for earlier pain control. Overall, protocol-based pain management facilitated faster pain control, leading to more effective medical management – an approach that can be applied to hospital-wide admissions involving pain.