Education for Improvement: Decreasing the Gap Between Sickle Cell Analgesia Guidelines and Clinical Practice

Background

Patients with sickle cell disease (SCD) commonly present to the emergency department (ED) with acute pain episodes that require timely opioid analgesia. The American Society of Hematology (ASH) recommends administration of opioid pain medication within 30-60 minutes of arrival. However, delays in delivering analgesics are common and are linked to poorer clinical outcomes, including acute chest syndrome, prolonged hospitalizations, and reduced patient satisfaction. At the UMass Medical Center ED, baseline data demonstrate a median time-to-first opioid administration of 85 minutes, with only 34% of SCD encounters having a time-to-first opioid within the recommended 60-minute timeframe. These findings highlight a significant gap between evidence-based guidelines and current practice, underscoring the need for targeted quality improvement (QI). To address this gap, we administered an active-learning educational intervention to the ED clinicians.

Methods

A single-site QI initiative was conducted in an academic ED in central Massachusetts. After multidisciplinary stakeholder groups met, a targeted intervention for ED clinicians was administered, including attending physicians and residents. This education session was crafted using Bloom’s Taxonomy. The intervention consisted of learning objectives that used measurable verbs to outline competency expectations explicitly. We extracted pre-intervention and post-intervention data from the Electronic Health Record (EHR) for adult patients who presented to the UMass ED between January 2024 and October 2025. These were analyzed in R. The gathered information was deidentified.

Results

There were 101 patients across 310 encounters during the study period, with a median age of 28 years, 49.5% female, and primary languages of English (88.1%), Spanish (5.9%), Haitian Creole (5.0%), and Portuguese (1.0%) (Table 1). Following an educational intervention for emergency medicine clinicians, the median time to first opioid decreased from 85 to 75 minutes (p = 0.23), and the proportion of patients receiving an opioid within 60 minutes increased from 34% to 36% (p = 0.72). However, these changes were not statistically significant. The median time-to-first opioid increased from 84 minutes to 93 minutes for encounters with female patients (p = 0.45), and decreased from 87 minutes to 72 minutes for encounters with male patients (p = 0.04) (Table 2). There was some initial improvement immediately after the educational intervention, median time to first opioid subsequently increased, and the proportion of encounters with time to first opioid under 60 minutes decreased over later quarters (Figure 1).

Conclusions

While education shows no statistically significant improvement in a large system, our data show short-term benefits that may be augmented if repeated over time. By using a targeted, active-learning educational intervention, we improved adherence to ASH guidelines. Future projects will work on system changes within the EHR to further bridge the gap between guidelines and practice.

Demographic and language characteristics

Median time-to-first opioid of encounters