Background: Patients hospitalized for vaso-occlusive crisis (VOC) frequently report dissatisfaction with pain management, which is exacerbated by variability in treatment approaches across healthcare providers. Negative provider perceptions, stigmatized language in the electronic medical record, and misperceptions of appropriate pain management are associated with undertreatment of pain, prolonged hospitalizations, and worse disease-specific outcomes. Effective management of pain and crisis resolution remains a significant challenge for individuals with sickle cell disease.
Purpose: The aim of this initiative was to establish a standardized, evidence-based protocol for the management of patients with sickle cell disease presenting with VOC in the hospital setting. This protocol sought to reduce variability in care, improve patient satisfaction, and ensure consistent, high-quality management of pain and other aspects of VOC treatment.
Description: A multidisciplinary team was formed, including hospitalists, hematology/oncology specialists (both inpatient and outpatient), addiction medicine specialists, and palliative care providers. Discussions with providers at five other peer academic institutions provided a framework for implementing an evidence-based protocol at our institution. Our multi-disciplinary team collaborated to create a Standard Operating Procedure (SOP) for managing sickle cell patients with acute VOC. The SOP includes guidelines for initial management in the Emergency Department (ED), clear goals for hospitalization (including pain control, hydration, and crisis resolution), a structured approach to evidence-based multi-modal pain management with opioid and non-opioid options, including the use of patient-controlled analgesia (PCA), and recommendations for when specialist consultation is advised. Additionally, the protocol provides recommendations for managing patients who demonstrate difficulty weaning from parenteral medications to a transitional pain regimen and outlines the expected duration of a typical VOC crisis. Given advances in interventional radiology in the treatment of acute sickle cell vaso-occlusive pain crisis, we also partnered with colleagues who have expertise in this area as another option for treatment of pain.
Conclusions: The development of a comprehensive SOP for managing VOC in hospitalized patients with sickle cell disease has the potential to significantly reduce care variability and improve patient outcomes. By standardizing pain management protocols and defining clear treatment goals, we expect to enhance patient satisfaction, reduce the duration of hospital stays, and improve the consistency of care across hospitalist teams. Future evaluation will focus on monitoring outcomes such as patient pain scores, hospital length of stay, readmission rates, and engagement with outpatient providers and therapies, as well as assessing the protocol’s impact on healthcare provider confidence and patient experience.