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Evidence-Based Practice Standard Care for Acute Pain Management in Adults With Sickle Cell Disease in an Urgent Care Center

Kim, Sunghee DNP, RN, ANP-BC, NP-C; Brathwaite, Ron MD; Kim, Ook MD

Quality Management in Healthcare: April/June 2017 - Volume 26 - Issue 2 - p 108–115
doi: 10.1097/QMH.0000000000000135
Quality Improvement Initiatives

Background: Vaso-occlusive episodes (VOEs) with sickle cell disease (SCD) require opioid treatment. Despite evidence to support rapid pain management within 30 minutes, care for these patients does not consistently meet this benchmark. This quality improvement study sought to decrease the first analgesic administration time, increase patient satisfaction, and expedite patient flow.

Methods: A prospective pre-/postevaluation design was used to evaluate outcomes with patients 18 years or older with VOEs in an urgent care (UC) center after implementation of evidence-based practice standard care (EBPSC). A pre- and postevaluation survey of SCD patients' satisfaction with care and analogous surveys of the UC team to assess awareness of EBPSC were used. A retrospective review of the electronic medical records of patients with VOEs compared mean waiting time from triage to the first analgesic administration and the mean length of stay (LOS) over 6 months.

Results: Implementing EBPSC decreased the mean time of the first analgesic administration (P = .001), significantly increased patient satisfaction (P = .002), and decreased the mean LOS (P = .010).

Conclusion: Implementing EBPSC is a crucial step for improving the management of VOEs and creating a positive patient experience. The intervention enhances the quality of care for the SCD population in a UC center.

Department of Family Medicine, Loma Linda University Medical East Campus Hospital Urgent Care, Loma Linda, California (Drs S. Kim and Brathwaite); and Department of Internal Medicine, Loma Linda University Medical Center, Loma Linda, California (Dr O. Kim).

Correspondence: Sunghee Kim, DNP, RN, ANP-BC, NP-C, Loma Linda University Medical East Campus Hospital Urgent Care, 25333 Barton Rd, Loma Linda, CA 92354 (

The authors thank Mary Terhaar, DNSc, RN, FAAN, Associate Dean of Academic Affairs, Case Western Reserve University School of Nursing, for being an advisor. The authors also thank Ramon Issa, MD, Medical Director of the Urgent Care Center, Department of Family Medicine, Loma Linda University Medical East Campus Hospital and the Urgent Care, nursing staff.

The authors declare no conflict of interest.

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