Quality Improvement Process in a Sickle Cell Infusion Center

Background: The American Pain Society recommends that individuals experiencing sickle cell crisis receive parenteral pain medication within 30 minutes of assessment. We examined factors affecting achievement of this standard at the Johns Hopkins Sickle Cell Infusion Center. Methods: Baseline patient care time intervals and data on variables affecting the ability to achieve the American Pain Society goal were measured. Time to first parenteral opiate administration was modeled using simple and multivariable linear regression. Results: Mean time from initial assessment to first dose was initially 41 minutes. Increased nurse to patient ratio decreased time to first dose. Conclusions: Of the factors associated with improved times to first dose, only nurse to patient ratio is amenable to process change, suggesting it as a potential target for future interventions.