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

项目总结 镰状细胞病(SCD)是一种遗传性血液疾病，影响着美国约36,000名儿童 大约90%的州是黑人。这种疾病的特点是反复出现严重的疼痛危机。 这导致急诊科就诊率和住院率高，并降低了生活质量。 国家心脏、肺和血液研究所以及美国血液病学会已经批准了 关于对出现这些急性疼痛的儿童进行及时护理的疼痛管理指南 危机。这些以证据为基础的指南很少被遵循，导致疼痛和 住院治疗。除了遵循指导方针的其他障碍外，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的使用时间。 我们的长期目标是改善急性疼痛血管闭塞儿童的护理和健康结果 危急情况在急诊科处理。我们的总体目标是使用多方面测试护理路径 实施战略，以增加急诊科对儿童的遵守指南的护理 急性疼痛血管闭塞危象。我们的主要目标是：1)比较主要执行成果 儿童急性痛性血管病变护理路径的可及性、采纳性和实施性 急诊科的闭塞性危机，对照组和干预组之间，2)比较 遵循指南的阿片类药物给药时机、住院率和疼痛的主要临床结果 儿童急性痛性血管闭塞危象的护理路径评分 急诊科分为对照组和干预组。我们将使用随机的、 进行III型混合有效性的多中心阶梯式楔形设计--护理实施试验 路径。我们的提案将建立跨越七个急诊科的护理路径，目标是 改善对表现为急性疼痛危象的SCD儿童的遵循指南的护理，从而改善 减少这一弱势群体的痛苦、减少住院和提高生活质量。

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.