Many SCD patients do not have access to coordinated care and rely on emergency epartment (ED) visits to manage their pain. Inconsistent pain treatment leads to longer hospitalizations and patient distress. Patients with SCD often cite the care that is delivered in the ED as the area of health care in greatest need of improvement. In 2014, the National Heart, Lung, and Blood Institute released guidelines for the care of SCD, including recommendations for the management of acute sickle cell pain in the ED. The guidelines suggest that patients with SCD should be assessed and triaged rapidly, assigned high priority for evaluation by a physician, and receive their first analgesic within 60 minutes of arrival to the ED (or 30 min from triage). The goal of this study is to determine factors associated with variability in the assessment and treatment of SCD patients presenting to the ED with acute pain. Design: We performed a cross-sectional analysis of SCD patients with pain crisis. Setting: ED of an urban, community university-affiliated teaching hospital. Participants: From 1/1/15 to 12/31/17, all SCD patients presenting to the adult ED with acute pain constant with vaso-occlusive crisis; excluding patients who presented for traumatic injuries or complaints where pain was not part of their reason for visit. Measures: Patient characteristic variables included age, sex, self-reported race, insurance, triage category, reason for visit, presenting pain score and disposition. Differences in pain management process outcomes included the following: 1) time in minutes from arrival to administration of first analgesic, and 2) triage to administration of first analgesic change in pain scores. Analgesic agents used and routes of administration were coded. Descriptive statistics are reported with standard deviations. We compare continuous data using 2-tailed Student’s t-test; categorical data were analyzed with the chi-squared test. A total of 218 patients with 896 unique visits were recorded during our study period. The mean age of the population was 33 yrs, 76% female, 92% black, 81% non-Hispanic, and 68% had public insurance or were self-pay. Using regression modeling, patients who met the NHLBI recommended time to first analgesia under 1 hr from time of arrival were 6.2 more likely (95% CI 3.9-9.7) to be determined to be ESI level 2. There were no other statistically significant differences in patient (demographics, reason for visit, presenting pain score) or treatment variables (type and route of administration of analgesic) identified. 119 of the 896 encounters were triaged as ESI level 2. This cohort was more likely to meet the goal of analgesia within 30 minutes of triage (OR 3.8, 95% CI 2.7-5.5). Patients identified as ESI level 2 were not more likely to be admitted (1.2, 95% CI 0.9-1.7). Pain management of SCD patients remains a challenge. Our review reveals wide variability in the quality of care provided based on the NHLBI recommendations. We uncovered a significant opportunity for improvement related to the triage assessment. The association between ESI triage level and time to first analgesia suggests the importance of incorporating the ESI guidelines for triage of SCD patients.Tabled 1Patient Characteristics & ED Approach to Pain ManagementPatient CharacteristicsPain Management ProcessReason for visit (pain)First AnalgesicMSK91.3%Narcotic76.2%Chest5.2%Parenteral (route)85.8%ABD3.2%Presenting Pain Score (1-10)8.0 (+/- 1.5 s.d.)Door (registration) to 1st AnalgesicMean: 1:40 hr; Median 1:21 hr5 Severe Pain (PS 7-10)88.8 %% given in <1 hr36.0%Triage (ESI level)Level 213.4%Triage to 1st AnagesicMean: 1:31 hr; Median: 1:12 hrLevel 386.6%% given in <30 min20.0%DispositionAdmitted (Hospital LOS_median)66.3% (5.0 +/- 0.2 days)Discharged (ED LOS_median)33.7% (6.5 +/- 0.7 hrs) Open table in a new tab