Objective: To determine whether a protocol to start patient-controlled analgesia (PCA) in the emergency department (ED-PCA) would shorten the length of time between narcotic bolus doses and PCA initiation as compared with standard inpatient initiation of PCA (IP-PCA). Also, to compare patient satisfaction and inpatient length of stay for the 2 groups.
Methods: To improve care, we developed a protocol to institute ED-PCA after an initial bolus dose of narcotics. This was a nonrandomized pilot study. Patient records were reviewed for location of PCA initiation, time from narcotic bolus to initiation of PCA, and length of stay. A brief patient/parent satisfaction survey was collected.
Results: Sixty-nine records were reviewed. Patients treated using the protocol had initiation of PCA therapy within 35 ± 7 minutes from the last bolus narcotic dose in the emergency department versus 211 ± 17 minutes for nonprotocol patients. Forty-eight of 50 patient surveys indicated preference for starting ED-PCA; 2 did not have a preference. No complications were identified in either group.
Conclusions: A protocol to initiate PCA for sickle cell patients in a pediatric emergency department shortened the time of its initiation and was preferred by patients.
Sickle cell anemia is a chronic hemolytic anemia frequently complicated by severe, painful vaso-occlusive episodes. 1 The emergency department is a common site for the initial management of those episodes unsuccessfully controlled at home. Treatment is primarily supportive and includes fluids, oxygen for hypoxia, and narcotic analgesics. 2 In our pediatric emergency department, we used bolus doses of intravenous narcotics for analgesic management.
A retrospective chart review of sickle cell patients admitted with vaso-occlusive crises in our institution in 1997 identified a mean 4-hour interval between the last narcotic dose administered in the emergency department (ED-PCA) and the first narcotic dose administered by patient-controlled analgesia (PCA) pump on the inpatient unit (IP-PCA). These patients often experienced recurrence or exacerbation of pain during these analgesia-free intervals. In our institution, PCA has been reserved for inpatient management of children developmentally able to master the use of the PCA pump technology.
The objective of this study was to determine the impact of PCA therapy initiated in the emergency department on (1) the time from the last narcotic bolus dose to the initiation of PCA therapy, (2) the length of inpatient admission for vaso-occlusive crisis treatment, and (3) patient satisfaction.