395 - Decreasing Time to Opioid Pain Medication Administration for Acute Sickle Cell Pain in the Pediatric Emergency Room

Publication Number: 4387.395

Anjali R. Oberoi, UMass Chan Medical School, Worcester, MA, United States; Ty Meka, University of Massachusetts Medical School, Worcester, MA, United States; Kathryn M. Burke, UMass Memorial Children's Medical Center, Warwick, RI, United States; Inbar Plaut, UMass Memorial Children's Medical Center, Worcester, MA, United States; Christina Hermos, UMASS MEMORIAL CHILDREN'S MEDICAL CENTER, Worcester, MA, United States; Nura El-Haj, University of Massachusetts Medical School, Worcester, MA, United States

Background: Pediatric patients with sickle cell disease (SCD) experience acute pain episodes requiring timely opioid administration in the emergency department (ED). The American Society of Hematology recommends delivery of opioid pain medication within 30 to 60 minutes of arrival to the ED. Postponed administration of adequate analgesia can negatively impact clinical outcomes, including increased secondary complication rates, longer hospitalizations, and lower patient satisfaction. In the UMass Children's Medical Center Pediatric ED (PED), the mean time to first opioid pain medication administration was 76 minutes, and opioids were administered within the first 60 minutes for only 46% of all encounters.

Objective: Our objectives were to reduce the mean time to opioid pain medication administration for pediatric patients with SCD in the UMass PED to 45 minutes and to increase the number of patients receiving opioid pain medication in the first 60 minutes to 75% by Quarter 3 2025.

Design/Methods: We conducted a single-site quality improvement initiative (QI) at an academic pediatric ED in central Massachusetts. We utilized the LEAN methodology and assembled a multidisciplinary stakeholder meeting to create a process map, conduct a root cause analysis, and identify countermeasures. Multiple "Plan Do Study Act (PDSA)" cycles were completed, including implementation of integrated order sets in the electronic health record (EHR) and targeted education sessions for pediatric ED personnel, including residents, attending providers, and nurses. All patient care during the study period adhered to existing evidence-based practices, with no deviations from standard protocols.
Data for patients < 18 years old presenting to the UMass Children's Medical Center PED from 1/1/2023-9/30/2025 were obtained from the EHR and analyzed in R. Only aggregate, de-identified data were used for analysis. The study team assessed process improvements using Statistical Process Control (SPC) charts.

Results: Following targeted countermeasures, the average time to opioid medication decreased from 76 minutes to 60 minutes (Figure 1). The proportion of patients receiving opioids within 60 minutes of arrival increased from 46% to 67% (Figure 2).

Conclusion(s): Ongoing QI efforts can meaningfully reduce opioid administration delays, but sustained improvement is challenging. While we saw improvement in the timeliness of pain medication administration, we did not meet our goals. Future PDSA cycles will focus on developing clinical practice guidelines and EHR-integrated reminders.

Figure 1. SPC chart showing the quarterly mean time (in minutes) from arrival to opioid medication administration for pediatric SCD patients in the ED, spanning Q3 2023 (Project Start) to Q3 2025.
Countermeasure points are marked, including project start, stakeholder meeting, order set implementation, and provider education initiatives. The center line marks the overall mean, with upper and lower control limits (UCL/LCL) and an institutional goal of 45 minutes indicated. The figure demonstrates trends in opioid administration time following countermeasures.

Figure 2. SPC depicting the percentage of pediatric SCD patients receiving opioid medication within 60 minutes of arrival to the ED, from Q3 2023 (Project Start) to Q3 2025.
Countermeasure time points are indicated, including project initiation, stakeholder meetings, order set implementation, and PED personnel education. The center line represents the mean percentage, with upper and lower control limits (UCL/LCL), and the institutional goal (75%) denoted by a dotted line. The chart illustrates improvement in timely opioid administration following implementation of countermeasures.