EXPLORING EMERGENCY DEPARTMENT PROVIDER EXPERIENCES WITH AND PERCEPTIONS OF WEIGHT-BASED AND INDIVIDUALIZED VASO-OCCLUSIVE TREATMENT PROTOCOLS IN SICKLE CELL DISEASE

INTRODUCTION: Treatment of vaso-occlusive episodes (VOE) are the most common reason for ED treatment of sickle cell disease (SCD). We 1) compared perceptions of the usability and ability to manage VOE pain between ED nurses and other ED provider types, ED sites, and VOE protocols (individualized versus weight-based), and 2) identified ED nurse and other provider protocol suggestions. METHODS: A secondary analysis of provider survey data collected immediately after caring for a patient enrolled in a randomized control trial comparing weight based vs. individualized opioid dosing for VOE. Research staff asked the ED nurse and other ED providers (nurse practitioners [NPs], physician assistants [PAs], residents and attending physicians) five questions related to the protocol’s ease of use and ability to manage pain. RESULTS: There were 236 surveys completed. Attending physicians (n=15), residents (n=88), PAs (n=21), and NPs (n=1) were more satisfied than nurses (n=111) with the clarity of the analgesic ordering (97.6% vs. 0%, p = 0.0001), and ability to manage the patient’s VOE pain (91% vs. 0%, p = 0.0001). When comparing both protocols with the usual ED strategy in their ED to manage VOE, more nurses than other ED providers perceived the study patients’ pain management protocol as better (100% vs. 35.2%, p = 0.0001).Other ED providers perceived the individualized versus weight-based protocol as better at managing pain than their usual ED strategy (70.3% vs. 59.5%, p = 0.04). CONCLUSION: The individualized protocol was perceived as better in managing VOE than the weight-based ED strategy. While physicians were satisfied with the clarity of the protocols, nurses were not. Improved protocol usability is required for widespread ED implementation.