Jasmine Umana (University of Chicago), Jessica Torre (University of Chicago), Megha Kilaru (University of Chicago), Vineet Arora (University of Chicago), John Fahrenbach (University of Chicago), Farah Ahmed (University of Chicago), Rebecca Chohlas-Wood (University of Chicago), Radhika Peddinti (University of Chicago)
Patients with sickle cell disease (SCD) are high utilizers of health care, in part due to frequent pain crises. National guidelines recommend individualized pain plans (IPP) for all patients with SCD, yet IPPs have not been widely implemented. IPPs lead to reduced hospital admission rates and to increased patient satisfaction.
To implement individualized pain plans within one year for all patients in the Adolescent and Young Adult (AYA) Clinic, a pediatric hematology/oncology transitional clinic for patients 18-25 yo with sickle cell disease at the University of Chicago Medical Center (UCMC).
The Individualized Pain Plan template was adapted from a prior study (Pediatr Blood Cancer 2014;61:1747–1753, Krishnamurti et al). IPPs include recommended home and ED pain regimens. IPPs are created at AYA clinic appointments and are only managed by AYA providers. Patients are given 2 laminated wallet cards describing their IPPs. IPPs are also added to the EMR’s problem list under “Vaso-occlusive crisis.” To promote awareness of the IPPs and to encourage adherence, collaborations were built with stakeholders in the UCMC Adult and Pediatric Emergency Departments, and educational sessions were held for nursing, residents and attendings.
33/33 (100%) of AYA patients with a clinic visit from 2/2017-1/2018 received an Individualized Pain Plan. During their most recent UCMC ED encounter for a pain crisis, 88% of patients’ first opioid medication was an opioid at the recommended dosage from the IPP (n=17). 82% of patients’ first non-opioid pain medication was from the IPP, but only 59% received the recommended IPP dosage. 47% of these visits were in UCMC’s adult ED, while the remainder were in UCMC’s pediatric ED.
The majority of providers in the University of Chicago Medical Center Emergency Departments are following the individualized pain plans. However, there is room for improvement in adherence to the recommended adjunctive pain medications.
Implications for the Patient
Previous studies evaluated implementation of IPPs within a single children’s hospital. To the author’s knowledge, this is the first study to describe and evaluate implementation of IPPs across both adult and pediatric emergency departments. This has significant potential to improve the transition of care for young adults with SCD.