Process implementation and outcomes associated with patient-controlled analgesia in the emergency department for adult sickle cell patients

Purpose

This pre/post retrospective observational study evaluates outcomes associated with initiation of hydromorphone patient-controlled analgesia (PCA) in the emergency department (ED) for adult sickle cell disease (SCD) patients presenting with vaso-occlusive episode (VOE).

Methods

Patients served as their own controls to reduce variability. Therefore, an ED presentation and admission between August 2023–November 2024 (post-implementation) was compared to a previous encounter between May 2021–May 2023 (pre-implementation).

Results

A total of 23 patients were included: mean age 31 years (IQR 27.5, 38), 62.5 % male, genotypes hemoglobin SC and SS (39.1 %, 39.1 %). Time to PCA initiation was reduced in the post-implementation group; 153 min (IQR 58.5, 478) vs. 91 min (IQR 60.5, 142), respectively (p = 0.045). There was no difference in highest reported pain score in the first 48 h of hospital admission, 8 (7, 9) for both groups (p = 0.21). Median morphine milligram equivalents (MME)/day was increased in post- compared to pre-implementation groups, 1208 mg (IQR 979, 3070) vs. 1171 mg (IQR 424, 1478) (p = 0.02), with higher opioid analgesia MME used in days 1–4 but then lower MME by days 5–7 comparatively. There was lower MME change from total prior to admission prescription dose to hospital discharge and less patients had an increase in opioid prescription dose in the post-implementation group in both cases. Length of stay and adverse events were similar.

Conclusion

Availability for PCA use in the ED for adult SCD patients shortened time to PCA initiation. This approach contributed to more consistent and timely pain management for SCD patients.