A Survey-Based Needs Assessment of Barriers to Optimal Sickle Cell Disease Care in the Emergency Department

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From: Annals of Emergency Medicine(Vol. 76, Issue 3)
Publisher: Elsevier B.V.
Document Type: Survey
Length: 690 words

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Abstract :

for the Sickle Cell Disease Implementation Consortium Study objective Guided by an implementation science framework, this needs assessment identifies institutional-, provider-, and patient-level barriers to care of sickle cell disease (SCD) in the emergency department (ED) to inform future interventions conducted by the multicenter Sickle Cell Disease Implementation Consortium. Methods The consortium developed and implemented a validated needs assessment survey administered to a cross-sectional convenience sample of patients with SCD and ED providers caring for them. In total, 516 adolescents and adults with SCD and 243 ED providers from 7 and 5 regions of the United States, respectively, responded to the ED care delivery for SCD survey. Results Survey results demonstrated that 84.5% of respondents with SCD have an outpatient provider who treats many patients with SCD. In the ED, 54.3% reported not receiving care fast enough and 46.0% believed physicians did not care about them and believed similarly of nurses (34.9%). Consequently, 48.6% of respondents were "never" or "sometimes" satisfied with their ED care. Of surveyed ED providers, 75.1% were unaware of the National Heart, Lung, and Blood Institute recommendations for vaso-occlusive crises, yet 98.1% were confident in their knowledge about caring for patients with SCD. ED providers identified the following factors as barriers to care administration: opioid epidemic (62.1%), patient behavior (60.9%), crowding (58.0%), concern about addiction (47.3%), and implicit bias (37.0%). Conclusion The results underscore that many patients with SCD are dissatisfied with their ED care and highlight challenges to optimal care on the practice, provider, and patient levels. Exploring these differences may facilitate improvements in ED care. Author Affiliation: (a) Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (b) Department of Nursing, Icahn School of Medicine at Mount Sinai, New York, NY (c) Center for Nursing Research and Innovation, Icahn School of Medicine at Mount Sinai, New York, NY (d) Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (e) Department of Hematology, St Jude Children's Research Hospital, Memphis, TN (f) Division of Hematology and Oncology, University of Alabama at Birmingham School of Medicine, Birmingham, AL (g) RTI International, Research Triangle Park, NC (h) School of Nursing, Duke University, Durham, NC (i) Department of Emergency Medicine, Medical College of Georgia, Augusta, GA (j) Division of Pediatric Hematology-Oncology, University of Illinois, Chicago, IL (k) Department of Pediatric Hematology and Oncology, Washington University in St. Louis, St. Louis, MO * Corresponding Authors. (footnote) Supervising editor: Donald M. Yealy, MD. Specific detailed information about possible conflict of interest for individual editors is available at https://www.annemergmed.com/editors(https://www.annemergmed.com/editors). (footnote) Authorship: All authors attest to meeting the four ICMJE.org(http://ICMJE.org) authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. (footnote) Funding and support : By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org(http://www.icmje.org)). The SCD Implementation Consortium was supported by US federal government cooperative agreements U24HL133948, U01HL133964, U01HL133990, U01HL133996, U01HL133994, U01HL133997, U01HL134004, U01HL134007, and U01HL134042 from the National Heart, Lung, and Blood Institute and the National Institute on Minority Health and Health Disparities (Bethesda, MD). Publication of this supplement was supported by the Office of Minority Health of the US Department of Health and Human Services. Byline: Elizabeth A. Linton, MPH (a), Dania A. Goodin, MD [Dania.Goodin@mountsinai.org] (a,*), Jane S. Hankins, MD, MS (e), Julie Kanter, MD (f), Liliana Preiss, MS (g), Jena Simon, FNP-BC, MS (b), Kimberly Souffront, PhD, FNP-BC (a,c), Paula Tanabe, PhD (h), Robert Gibson, PhD (i), Lewis L. Hsu, MD, PhD (j), Allison King, MD, MPH (k), Lynne D. Richardsona, MD (d), Jeffrey A. Glassberg, MD, MA (a)

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Gale Document Number: GALE|A640420792