Sickle Cell Improvement: ENhancing Care in the Emergency Department (SCIENCE)

项目摘要 镰状细胞病（SCD）是一种遗传性血液疾病，在美国约有36，000名儿童受到影响。 在美国，大约90%是黑人。这种疾病的特点是反复发作，严重的疼痛危机 这导致急诊科就诊率和住院率高，生活质量下降。 国家心肺血液研究所以及美国血液学会已经认可 疼痛管理指南，关于对出现这些急性疼痛的儿童进行及时护理 危机这些基于证据的指南很少被遵循，导致疼痛增加， 住院治疗除了妨碍遵循准则的其他障碍外，还提出了结构性种族主义， 作为一个重要的贡献者，新英格兰医学杂志最近呼吁建立SCD- 具体的疼痛管理协议，以打击结构性种族主义和减少阿片类药物管理的时间。 我们的长期目标是改善患有急性疼痛性血管闭塞性疾病的儿童的护理和健康结果。 在急诊室处理的危机。我们的总体目标是测试一个护理途径， 实施战略，以增加急诊科儿童的指导原则， 急性疼痛性血管闭塞危象我们的主要目标是：1）比较主要实施结果 达到，采用和实施的护理途径，治疗儿童急性疼痛血管， 在急诊科，对照组和干预组之间的闭塞性危象; 2）比较 阿片类药物给药时间、住院率和疼痛指南依从性治疗的主要临床结局 治疗儿童急性疼痛性血管闭塞危象的护理路径评分 控制组和干预组之间的急诊室。我们将使用一个随机的， 多中心阶梯式楔形设计，进行III型混合有效性-实施试验 通路我们的提案将在七个急诊科建立护理路径，目标是 改善对出现急性疼痛危象的SCD儿童的指南依从性护理，从而改善 疼痛，减少住院治疗，改善这一弱势群体的生活质量。

PROJECT SUMMARY Sickle cell disease (SCD) is an inherited blood disorder affecting approximately 36,000 children in the United States, approximately 90% of whom are Black. The disease is characterized by recurrent, severe pain crises which result in high rates of emergency department visits and hospitalizations, and decreased quality of life. The National Heart, Lung and Blood Institute, as well as the American Society of Hematology, have endorsed pain management guidelines regarding the timeliness of care for children presenting with these acute pain crises. These evidence based guidelines are infrequently followed, resulting in increased pain and hospitalizations. In additional to other barriers to following the guideline, structural racism has been proposed as a significant contributor and the New England Journal of Medicine recently called for the institution of SCD- specific pain management protocols to combat structural racism and reduce time to opioid administration. Our long-term goal is to improve the care and health outcomes of children with acute painful vaso-occlusive crisis treated in the emergency department. Our overall aim is to test a care pathway using multifaceted implementation strategies to increase guideline adherent care for children in the emergency department with acute painful vaso-occlusive crisis. Our primary aims are: 1) To compare the primary implementation outcomes of Reach, Adoption, and Implementation for the care pathway for treatment of children with acute painful vaso- occlusive crisis in the emergency department, between control and intervention groups and 2) To compare the primary clinical outcomes of guideline adherent care for opioid dose timing, hospitalization rates, and pain scores for the care pathway for the treatment of children with acute painful vaso-occlusive crises in the emergency department between control and intervention groups. We will test these aims using a randomized, multicenter stepped wedge design to conduct a type III hybrid effectiveness-implementation trial of the care pathway. Our proposal will institute the care pathway across seven emergency departments with the goal of improving guideline adherent care for children with SCD presenting with an acute pain crisis, thereby improving pain, decreasing hospitalizations and improving quality of life for this vulnerable population.