Improving Pain Management of Sickle Cell Patients in the Emergency Department

Patients with Sickle Cell Disease (SCD) presenting to the Emergency Department (ED) for vaso-occlusive episodes (VOE) often face delays in pain management. National guidelines recommend priority triaging (ESI level 2) and a time-to-first-analgesic-dose (TFA) of less than 60 minutes. Our objective was to evaluate a multidisciplinary quality improvement (QI) initiative to increase the percentage of SCD patients achieving TFA under 60 minutes from a baseline of 29% to a target of 60%.

A multidisciplinary team utilized QI methodology involving Plan-Do-Study-Act (PDSA) cycles evaluating patients with a diagnosis of SCD and a chief complaint of pain from January 1, 2024, to November 30, 2025. Cycle1 (September 2024) established a departmental triage policy to assign ESI level 2 for all SCD-related pain. Cycle 2 (August 2025) launched a “heme alert”; an overhead notification, prioritizing high acuity side rooming and rapid evaluation by team members to improve overall care coordination. Statistical significance was determined with the utilization of standard t-tests and run charts were used to evaluate median times to medication administration.

A total of 824 encounters were analyzed with 297 (36%) pre-intervention and 527 (64%) post-intervention. 413 (50.1%) male and a mean age of 31 (Std Dev 8). Regarding race, 767 (93%) identified as African American, 49 (6%) did not disclose or identify with a specific race and 8 (1%) identified as American Indian/Native American or White. Baseline performance, 143 (49%) were triaged as acuity level 2 compared to 296 (80%) after the first PDSA cycle and 149 (95%) in the second PDSA cycle. Median time to administration of first dose analgesia during the pre-intervention cycle was 81 minutes [IQR 56-116] compared to 68 minutes [46-106] after the first PDSA cycle, and 46 minutes [31-66] in the second PDSA cycle. Pre-intervention average TFA was 97 minutes with a decrease to 80 minutes after the first PDSA cycle (p< 0.001) and 55 minutes after the second PDSA cycle (p< 0.001).

Implementation of a standardized high-acuity triage policy and a rapid-response alert improved the timeliness of analgesia for patients with SCD. This system-wide, scalable model effectively bridges the gap between clinical guidelines and ED operational reality to improve health equity.