Chicago nurses lead charge to speed up SCD emergency care: Study
Project aimed at delivering pain relief to patients more quickly
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Through a project aimed at building empathy and understanding among clinicians about sickle cell disease (SCD)-related pain episodes, a team of nurses in Chicago has helped standardize emergency care for these complications and reduce door-to-painkiller time, according to a study.
“I set out on this initiative with a very clear intention: to create a meaningful difference in how we care for patients with sickle cell disease. Not just in outcomes, but in how we see them, how we respond to them, and how seriously we take their pain,” Britney Daniels, one of the nurses who helped lead the project, said in a written Q&A with Sickle Cell Anemia News.
Daniels and colleagues described their experiences in the study “Decreasing Door-to-Analgesia Time: Increasing Use of Sickle Cell Pain Management Pathway,” which was published in the Journal of Emergency Nursing.
Nurse’s experience of seeing patients’ pain dismissed inspired project
SCD is a genetic disorder in which blood cells become deformed, making them prone to getting stuck in blood vessels. This can lead to excruciatingly painful complications called vaso-occlusive crises or VOCs. Because VOCs are so painful, it’s recommended that SCD patients seeking emergency treatment for a VOC receive pain-relieving medication, or analgesia, as soon as possible.
This project, which Daniels undertook as part of her doctoral thesis, was largely inspired by the ways she’d seen her clinical colleagues dismiss the pain of people with this disorder, which disproportionately affects Black people and African Americans.
“Throughout my years of travel nursing, no matter what city, county, or state I was in, when a sickle cell patient checked in, I heard various medical professionals voice complaints, doubts, and judgment,” Daniels said. “I knew that changing their attitudes would be difficult, so I decided I would make the treatment of sickle cell pain more objective.”
At the University of Chicago’s Comer Children’s Hospital, “VOCs are a common cause of [emergency department] visits,” the researchers wrote.
An existing protocol recommended that SCD patients experiencing a VOC be treated with intranasal fentanyl, where fentany, a common opioid, is administered into the nose through a special device.
This allows patients to start getting relief before an intravenous (IV) needle is inserted to administer other analgesics. Daniels said this treatment “is effective, working in as few as 5 minutes, and provides pain relief before a needle is inserted.”
However, “interviews revealed that most nurses and some physicians were unaware of [the protocol’s] existence,” the researchers wrote, adding that “this gap in awareness contributed to significant delays and variability in the delivery of pain management.”
Daniels believes that healthcare providers’ attitudes toward SCD can play a big part in these delays.
“I have worked with some physicians who are passionate about sickle cell, so they immediately place medication orders and try to expedite the patient’s rooming,” she said. “I have also worked with physicians who are vocal about their disdain for caring for patients with sickle cell, and their timeliness for placing orders reflects that.”
The nurse also noted that negative attitudes from nurses can cause a delay in medication administration, as can difficulties in obtaining a good vein for treatment administration.
Effort aims to standardize pain management
Aiming to standardize pain management in pediatric SCD patients presenting to the hospital’s emergency department and reduce delays in pain medication administration, the research project included three main components.
The first involved a campaign to increase education and awareness among healthcare providers about the established pain protocol.
“It wasn’t just about teaching people how to use intranasal fentanyl; it was about reinforcing that sickle cell pain is real, urgent, and deserving of timely treatment,” Daniels said.
The second component involved developing an alert in the hospital’s electronic health record system that “prompted the nurse to notify the attending physician for an [intranasal fentanyl] order when a [VOC] was documented,” the researchers wrote.
For the third component of the project, Daniels and colleagues created an educational flyer geared toward SCD families to explain the safety and benefits of intranasal fentanyl in the treatment of VOCs.
This project was my attempt to … shift perspective, even slightly. Because if we can begin to see sickle cell pain not through a lens of doubt or frustration, but through urgency, compassion, and accountability, then we are already changing the trajectory of care. And for me, that shift, no matter how small, is where real change begins
A total of 40 pediatric SCD patients were included in the pre-intervention analysis, and 64 were included in the post-intervention analysis. All were African American and non-Hispanic, and the mean age in both groups was about 16 years.
Results showed that wait times for analgesia ranged from 12 to 244 minutes (more than four hours) before the interventions were implemented, and dropped to a range of 9 to 193 minutes (just over three hours) after the interventions. The mean time to pain medication administration dropped from 82.2 to 67.7 minutes.
While these differences failed to reach statistical significance, “these findings may have clinical implications,” the team wrote.
“When patients experience highly variable wait times, it often reflects underlying bias, workflow inefficiencies, or gaps in protocol adherence,” Daniels said. “By tightening that range, the project helped move care toward a more standardized approach, where patients are less dependent on who their provider is or what shift they arrive on.”
Daniels noted that more work is needed, around the world, to increase compassion for people dealing with pain due to SCD.
“This project was my attempt to … shift perspective, even slightly,” Daniels said. “Because if we can begin to see sickle cell pain not through a lens of doubt or frustration, but through urgency, compassion, and accountability, then we are already changing the trajectory of care. And for me, that shift, no matter how small, is where real change begins.”
