{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T02:38:57Z","timestamp":1780627137290,"version":"3.54.1"},"reference-count":16,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2018,6,1]],"date-time":"2018-06-01T00:00:00Z","timestamp":1527811200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Vaso\u2010occlusive crisis (VOC) is frequent in children with sickle cell disease (SCD) creating significant burden on patients, families, and emergency departments (ED). The objective of the project was to reduce the admission rate for children with SCD presenting to our ED with VOC by\u00a0&gt;20% within 6 months of initiating individualized pain plans (IPP).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A multi\u2010disciplinary quality improvement team was assembled. A Plan\u2010Do\u2010Study\u2010Act (PDSA) format was employed. The IPP document was created in a unique folder within the electronic medical record. IPPs were created through retrospective chart review for our 80 highest resource users. Pediatric residents, ED residents, and ED attending physicians were instructed on use of the IPPs. Our study measured the presence of an IPP, adherence to the IPP, and time to opiate administration. Our primary outcome was admission rate. Length of stay and 72\u2010hr return to the ED were assessed as balancing measures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, admission rate decreased by 24% following implementation compared with the previous 5 years (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.046). IPPs were created for 78% of patients and followed by ED staff in 86% of visits. Admission rate was significantly lower for patients receiving a second opiate dose within 45\u00a0min of the first dose (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.01). There was no difference in readmission rate or 72\u2010hr return rate to ED.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study presents an effective strategy to reduce admission rate for children with SCD presenting with VOC. Shorter time to second opiate dosing was also associated with reduced risk of admission.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.27274","type":"journal-article","created":{"date-parts":[[2018,6,1]],"date-time":"2018-06-01T12:50:07Z","timestamp":1527857407000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["A novel approach to reducing admissions for children with sickle cell disease in pain crisis through individualization and standardization in the emergency department"],"prefix":"10.1002","volume":"65","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5730-1897","authenticated-orcid":false,"given":"Matthew R.","family":"Schefft","sequence":"first","affiliation":[{"name":"Division of Pediatric Hematology Oncology and Stem Cell Transplantation Children's Hospital of Richmond, Virginia Commonwealth University and Massey Cancer Center  Richmond Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitlan","family":"Swaffar","sequence":"additional","affiliation":[{"name":"Virgnia Commonwealth University School of Medicine  Richmond Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Newlin","sequence":"additional","affiliation":[{"name":"Division of Pediatric Hematology Oncology and Stem Cell Transplantation Children's Hospital of Richmond, Virginia Commonwealth University and Massey Cancer Center  Richmond Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cady","family":"Noda","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Services Virginia Commonwealth University Health System  Richmond Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"India","family":"Sisler","sequence":"additional","affiliation":[{"name":"Division of Pediatric Hematology Oncology and Stem Cell Transplantation Children's Hospital of Richmond, Virginia Commonwealth University and Massey Cancer Center  Richmond Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,6]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2009.12.022"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.21408"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2010.01.001"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.24864"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2014.08.003"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.25024"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2014-2874"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2010-1791"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.emc.2014.04.011"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1080\/15265161.2013.767954"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/qhc.12.6.458"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2009.01.003"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2014-3470"},{"key":"e_1_2_10_15_1","first-page":"210","article-title":"Using quality improvement methods to implement an electronic medical record (EMR) supported individualized home pain management plan for children with sickle cell disease","volume":"21","author":"Crosby LE","year":"2014","journal-title":"J Clin Outcomes Manag"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.188351"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.23221"}],"container-title":["Pediatric Blood &amp; 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