Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
Ann Emerg Med. 2020 Sep;76(3S):S64-S72. doi: 10.1016/j.annemergmed.2020.08.013.
Guided by an implementation science framework, this needs assessment identifies institutional-, provider-, and patient-level barriers to care of sickle cell disease (SCD) in the emergency department (ED) to inform future interventions conducted by the multicenter Sickle Cell Disease Implementation Consortium.
The consortium developed and implemented a validated needs assessment survey administered to a cross-sectional convenience sample of patients with SCD and ED providers caring for them. In total, 516 adolescents and adults with SCD and 243 ED providers from 7 and 5 regions of the United States, respectively, responded to the ED care delivery for SCD survey.
Survey results demonstrated that 84.5% of respondents with SCD have an outpatient provider who treats many patients with SCD. In the ED, 54.3% reported not receiving care fast enough and 46.0% believed physicians did not care about them and believed similarly of nurses (34.9%). Consequently, 48.6% of respondents were "never" or "sometimes" satisfied with their ED care. Of surveyed ED providers, 75.1% were unaware of the National Heart, Lung, and Blood Institute recommendations for vaso-occlusive crises, yet 98.1% were confident in their knowledge about caring for patients with SCD. ED providers identified the following factors as barriers to care administration: opioid epidemic (62.1%), patient behavior (60.9%), crowding (58.0%), concern about addiction (47.3%), and implicit bias (37.0%).
The results underscore that many patients with SCD are dissatisfied with their ED care and highlight challenges to optimal care on the practice, provider, and patient levels. Exploring these differences may facilitate improvements in ED care.
在实施科学框架的指导下，本需求评估确定了医疗机构、提供者和患者在急诊科（ED）护理镰状细胞病（SCD）方面的障碍，为多中心镰状细胞病实施联盟未来开展的干预措施提供信息。
该联盟开发并实施了一项经过验证的需求评估调查，对来自美国 7 个和 5 个地区的 SCD 患者和 ED 提供者的横断面便利样本进行了调查。共有 516 名青少年和成年 SCD 患者和 243 名 ED 提供者分别对 SCD 的 ED 护理提供情况调查作出回应。
调查结果表明，84.5%的 SCD 患者有一位治疗许多 SCD 患者的门诊医生。在 ED，54.3%的患者报告称治疗速度不够快，46.0%的患者认为医生不关心他们，护士也是如此（34.9%）。因此，48.6%的受访者对他们的 ED 护理“从不”或“有时”感到满意。在所调查的 ED 提供者中，75.1%的人不知道国家心脏、肺和血液研究所对血管阻塞性危象的建议，但 98.1%的人对自己照顾 SCD 患者的知识有信心。ED 提供者认为以下因素是护理管理的障碍：阿片类药物泛滥（62.1%）、患者行为（60.9%）、拥挤（58.0%）、对成瘾的担忧（47.3%）和潜在偏见（37.0%）。
研究结果强调，许多 SCD 患者对他们的 ED 护理不满意，并突出了在实践、提供者和患者层面上实现最佳护理的挑战。探讨这些差异可能有助于改善 ED 护理。
