Background: Project Caring for Patients with Opioid Misuse through Evidence-Based Treatment (COMET) launched in 2019 to provide patients with opioid use disorders (OUD) individualized and evidence-based care at Duke University Hospital (DUH). Patients with OUD have higher rates of self-directed discharge (SDD) which is associated with higher healthcare utilization costs, hospital readmissions, and adverse health [...]

Background: Sickle cell disease (SCD) is characterized by lifelong, recurrent episodes of vaso-occlusive pain that often require inpatient hospitalization. Readiness for discharge is dictated by the patient’s pain intensity rated on the Numeric Rating Scale (0-10). Pain is an individualized multidimensional experience and a pain intensity score only measures one facet. Physical function is another [...]

Background: It is often challenging to assess pain in patients on chronic opioids either in acute care setting or in outpatient centers. Pain assessment in this group is more challenging especially if they are hospitalized with acute or acute on chronic pain. Opioid uses associated with increased pain perception and increased self-report of pain. Further, [...]

Background: Hospitals are compelled by a variety of factors to optimize patient satisfaction. Pain management has been identified as an important determinant of overall inpatient satisfaction. However, effective pain management may be more challenging in the current climate of more cautious opioid use. Purpose: The 32-item Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) [...]

Background: Opiates, frequently used to provide analgesia, are associated with post-analgesia related tolerance effects such as hyperalgesia and hyperkatifeia, which lead to worsening of the pain experience. Patients can subsequently experience dissatisfaction with their care and seek further opiate use as a solution, worsening their experience further. Due to pharmacologic and healthcare-associated operational factors, the [...]

Background: Chest pain accounts for 2-5% of all Emergency Room (ER) visits. Tools like TIMI score and HEART score exist to risk stratify patients, but a low threshold for admission has been traditional because the risk of inadvertent discharge of patients with true ACS. In this study, we evaluate the yield of myocardial perfusion scan [...]

Background: Coronary Computed Tomography Angiography (CCTA) is a common anatomic modality for detection of cardiac ischemia in the setting of chest pain hospitalizations. However, invasive coronary angiography (ICA) is the gold standard for diagnosing ischemic coronary artery disease. Research showed that CCTA has a high sensitivity but lacks the specificity and accuracy component of Fractional [...]

Background: Hydroxyurea is an FDA approved medication for use in adults with sickle cell disease. Clinical guidelines, based on high quality evidence, recommend its use in all adults with sickle cell anemia and 3 or more moderate to severe pain crises within one year.  Studies suggest its use to be inappropriately low. We assessed local [...]

Background: Opioids are widely prescribed for cancer and non-cancer related pain in hospitalized patients. The opioid usage increased roughly three times in the past two decades. Pain is a feeling of distress evoked by sensory stimuli with/without organ damage and an associated emotional experience. Considering the subjective nature of pain, the need for medication is [...]

Case Presentation: A 15 year old female with a history of severe persistent asthma, allergic rhinitis, and eczema presented with a two day history of cough, shortness of breath, and chest pain. She was diagnosed with asthma at age 13 and had eight presumed exacerbations and five diagnoses of pneumonia since that time. She was [...]