Background & Aims

Patients with sickle cell disease (SCD) often experience painful vaso-occlusive episodes (VOEs) requiring prolonged hospitalizations. Individualized care management with medications and non-pharmacologic treatments, such as massage therapy, have improved pain control and decreased length of stay (LOS). Massage therapy can reduce pain, stress, and need for analgesics. Early intervention with non-pharmacologic therapy is important for inpatient pain management of patients with SCD. Review of VOE admissions for patients with SCD at Children’s Mercy Hospital from January 1, 2023 to December 21, 2023 found 79% had a massage therapy consult placed within 48 hours of admission with a median number of 3.0 days from admission to consult note. Our primary aim was to decrease the time from admission to massage therapy completion from a median of 3.0 to 1.5 days by May 31, 2024 with a secondary outcome measure to decrease LOS from 5.0 to 4.0 days

Methods

For our Quality Improvement Project, our process measure was to increase consults ordered within 48 hours of admission from 79% to 95%. Our balancing measure monitored percentage of incomplete consult notes as a representation of effect on workload to remain stable at baseline 31%. For our first PDSA cycle starting on 12/22/2023, VOE admission orders were updated to include automatic massage therapy consults via our electronic medical record powerplan.

Results

Following PDSA cycle 1 (12/22/2023 – 03/31/2024), the median days from admission to consult completion decreased slightly to 2.7 days and LOS did not significantly change. The average percentage of massage therapy consults within 48 hours of admission increased to 96%. Incomplete massage therapy consults actually decreased to 19%.

Conclusions

Our goal is to decrease LOS for patients with SCD admitted for VOE by increasing the completion of massage therapy consults. PDSA cycle 1 led to an increase in massage therapy consults placed within 48 hours but did not change either the time from admission to consult completion or LOS. Future interventions to improve massage therapy consultation will require collaboration with massage therapists to identify barriers to consult completion and educating provider teams on the importance of adjunctive pain therapies.

References

Amanda M. Brandow, C. Patrick Carroll, Susan Creary, Ronisha Edwards-Elliott, Jeffrey Glassberg, Robert W. Hurley, Abdullah Kutlar, Mohamed Seisa, Jennifer Stinson, John J. Strouse, Fouza Yusuf, William Zempsky, Eddy Lang; American Society of Hematology 2020 guidelines for sickle cell disease: management of acute and chronic pain. Blood Adv 2020; 4 (12): 2656–2701. doi: https://doi.org/10.1182/bloodadvances.2020001851

Brown Bodhise, Dejoie, Brandon, Simpkins. Ballas (2004) Non-pharmacologic Management of Sickle Cell Pain, Hematology, 9:3, 235-237, DOI: 10.1080/10245330410001701495

Crawford C, Boyd C, Paat CF, Price A, Xenakis L, Yang E, Zhang W; Evidence for Massage Therapy (EMT) Working Group. The Impact of Massage Therapy on Function in Pain Populations-A Systematic Review and Meta-Analysis of Randomized Controlled Trials: Part I, Patients Experiencing Pain in the General Population. Pain Med. 2016 Jul 1;17(7):1353-1375. doi: 10.1093/pm/pnw099. PMID: 27165971; PMCID: PMC4925170.

Welch-Coltrane JL, Wachnik AA, Adams MCB, Avants CR, Blumstein HA, Brooks AK, Farland AM, Johnson JB, Pariyadath M, Summers EC, Hurley RW. Implementation of Individualized Pain Care Plans Decreases Length of Stay and Hospital Admission Rates for High Utilizing Adults with Sickle Cell Disease. Pain Med. 2021 Aug 6;22(8):1743-1752. doi: 10.1093/pm/pnab092. PMID: 33690845; PMCID: PMC8346918.

Presenting Author

Shailly Gaur

Poster Authors

Shailly Gaur

MD

Children's Mercy Hospital

Lead Author

Amy Johnson

MD

Children's Mercy Hospital

Lead Author

Topics

  • Treatment/Management: Pharmacology: Non-opioid