Kim Sunghee, Brathwaite Ron, Kim Ook
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).
Qual Manag Health Care. 2017 Apr/Jun;26(2):108-115. doi: 10.1097/QMH.0000000000000135.
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.
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.
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).
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.
镰状细胞病（SCD）的血管闭塞性发作（VOE）需要使用阿片类药物治疗。尽管有证据支持在30分钟内进行快速疼痛管理，但对这些患者的护理并未始终达到这一标准。这项质量改进研究旨在缩短首次镇痛给药时间，提高患者满意度，并加快患者流程。
采用前瞻性前后评估设计，对一家紧急护理（UC）中心实施循证实践标准护理（EBPSC）后18岁及以上VOE患者的结局进行评估。使用了对SCD患者护理满意度的前后评估调查以及对UC团队进行的类似调查，以评估对EBPSC的知晓情况。对VOE患者的电子病历进行回顾性审查，比较从分诊到首次镇痛给药的平均等待时间以及6个月内的平均住院时间（LOS）。
实施EBPSC缩短了首次镇痛给药的平均时间（P = .001），显著提高了患者满意度（P = .002），并缩短了平均住院时间（P = .010）。
实施EBPSC是改善VOE管理并创造积极患者体验的关键步骤。该干预措施提高了UC中心对SCD患者群体的护理质量。
