Recommended Citation
Smetana S, Rizvi I, Flejsierowicz M, Wankowski D, Adefisoye JO. A Quality Improvement Evaluation of Sickle Cell Pain Crisis Management in Community Hospitals: Assessing Length of Stay Data Across Inpatient Provider Groups. Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Abstract
Background/Significance:
Sickle cell disease (SCD) often results in vaso-occlusive pain crises (VOC), leading to recurrent emergency department visits and hospital admissions. American Society of Hematology (ASH) guidelines recommend rapid initiation of intravenous opioid therapy—within one hour of ED arrival— and standardized management pathways. Despite these recommendations, individuals with SCD remain under-recognized and under-treated in community hospitals. Practice variability may contribute to delayed analgesia, inconsistent patient-controlled analgesia (PCA) use, stigmatizing documentation, and prolonged hospital length of stay (LOS). Institutional review found inpatient VOC care processes and documentation as key targets for quality improvement.
Purpose:
To evaluate provider-group variation in LOS, PCA use, and timeliness to first IV opioid for inpatient VOC at two community hospitals, and to assess clinician documentation.
Methods:
This descriptive quality-improvement project occurred at Aurora Sinai Medical Center (230 beds) and St. Luke’s Medical Center (938 beds) and included adults ≥18 years admitted between 2020–2025 with VOC based on ICD-10 criteria, per an approved QI protocol. Comparative analyses included the Aurora Medical Group (AMG) hospitalist service and the Internal Medicine Teaching Service (IMTS); the Family Medicine Teaching Service was excluded due to low volume. Chart audits were performed, and chi-square and Wilcoxon tests were used with significance set at p<0.05.
Results:
73/81 admissions met inclusion criteria (AMG n=43; IMTS n=30). Genotypes included HbSS 84.9%, HbSC 6.8%, and unknown 8.2%. Door-to-IV opioid time was available for 70/73 admissions (median [IQR] 1.2 hours [0.7–2.1]). PCA was used in 35.7% of encounters, and 86.3% received IV fluids within 6 hours. No significant differences were seen between AMG and IMTS in median LOS (3.7 vs 3.0 days, p=0.075), PCA (y/n) use (35.7% vs 35.7%, p>0.999), or IV opioid choice (predominantly hydromorphone; p=0.115). However, AMA discharges differed significantly (7.0% vs 25.0%, p=0.032), with higher rates in the IMTS group. Chart audits found recurring documentation referencing opioid tolerance, prior pain regimens, and frequent admissions.
Conclusion:
Provider-group comparisons showed similar LOS, PCA use, and IV opioid selection, with higher AMA discharges in the IMTS group. Findings highlight opportunities for standardized VOC management, non-stigmatizing documentation, and future study of individualized inpatient pain plans.
Presentation Notes
Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Full Text of Presentation
wf_yes
Document Type
Poster
Open Access
Available to all.
A Quality Improvement Evaluation of Sickle Cell Pain Crisis Management in Community Hospitals: Assessing Length of Stay Data Across Inpatient Provider Groups
Background/Significance:
Sickle cell disease (SCD) often results in vaso-occlusive pain crises (VOC), leading to recurrent emergency department visits and hospital admissions. American Society of Hematology (ASH) guidelines recommend rapid initiation of intravenous opioid therapy—within one hour of ED arrival— and standardized management pathways. Despite these recommendations, individuals with SCD remain under-recognized and under-treated in community hospitals. Practice variability may contribute to delayed analgesia, inconsistent patient-controlled analgesia (PCA) use, stigmatizing documentation, and prolonged hospital length of stay (LOS). Institutional review found inpatient VOC care processes and documentation as key targets for quality improvement.
Purpose:
To evaluate provider-group variation in LOS, PCA use, and timeliness to first IV opioid for inpatient VOC at two community hospitals, and to assess clinician documentation.
Methods:
This descriptive quality-improvement project occurred at Aurora Sinai Medical Center (230 beds) and St. Luke’s Medical Center (938 beds) and included adults ≥18 years admitted between 2020–2025 with VOC based on ICD-10 criteria, per an approved QI protocol. Comparative analyses included the Aurora Medical Group (AMG) hospitalist service and the Internal Medicine Teaching Service (IMTS); the Family Medicine Teaching Service was excluded due to low volume. Chart audits were performed, and chi-square and Wilcoxon tests were used with significance set at p<0.05.
Results:
73/81 admissions met inclusion criteria (AMG n=43; IMTS n=30). Genotypes included HbSS 84.9%, HbSC 6.8%, and unknown 8.2%. Door-to-IV opioid time was available for 70/73 admissions (median [IQR] 1.2 hours [0.7–2.1]). PCA was used in 35.7% of encounters, and 86.3% received IV fluids within 6 hours. No significant differences were seen between AMG and IMTS in median LOS (3.7 vs 3.0 days, p=0.075), PCA (y/n) use (35.7% vs 35.7%, p>0.999), or IV opioid choice (predominantly hydromorphone; p=0.115). However, AMA discharges differed significantly (7.0% vs 25.0%, p=0.032), with higher rates in the IMTS group. Chart audits found recurring documentation referencing opioid tolerance, prior pain regimens, and frequent admissions.
Conclusion:
Provider-group comparisons showed similar LOS, PCA use, and IV opioid selection, with higher AMA discharges in the IMTS group. Findings highlight opportunities for standardized VOC management, non-stigmatizing documentation, and future study of individualized inpatient pain plans.
Affiliations
Aurora Sinai Medical Center, Aurora St. Luke’s Medical Center, Aurora UW Medical Group