Evaluating the American Society of Hematology quality measure on timeliness of analgesics for sickle cell disease pain crisis

ABSTRACT: The American Society of Hematology (ASH) proposed the median time to first emergency department (ED) administration of pain medication for patients with sickle cell disease (SCD) vaso-occlusive pain episodes (VOE) as a site-level quality measure. Generalizable studies assessing current guideline adherence recommending pain medications within 60 minutes are lacking. We leveraged multisite electronic health record data from Epic's Cosmos research platform to analyze ED encounters for SCD VOE from 1 January 2019 to 31 December 2024, with administration of at least 1 pain medication. We calculated the quality measure (median time to first pain medication) and ranked sites based on their timeliness. Lower values indicate more efficient pain management. We stratified the measure by medication type (opioid vs nonopioid) and administration route (oral vs parenteral) and compared the values across site-level characteristics (pediatric vs adult and encounter volumes). There were 474 409 SCD VOE encounters from 225 sites. Site encounter volumes ranged from <10 to 17 192. Overall, the quality measure ranged from 30 to 250 minutes; 86% of sites had values >60 minutes. Stratification by type and route revealed consistent median times of 81 to 82.5 minutes across 50th percentile-ranked sites. Median times from pediatric sites were 25 minutes (95% confidence interval, 19.5-86.5) lower than those from adult sites (58 vs 83 minutes; P = .001); encounter volume did not consistently influence site performance. Most sites performed poorly on the measure. These baseline data suggest that implementing the ASH-proposed quality measure could stimulate improvements in ED pain management.