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{
    "pk": 8043,
    "title": "Application of a Proactive Risk Analysis to Emergency Department Sickle Cell Care",
    "subtitle": null,
    "abstract": "Introduction: \nPatients with sickle cell disease (SCD) often seek care in emergency departments (EDs) for severe pain. However, there is evidence that they experience inaccurate assessment, suboptimal care, and inadequate follow-up referrals. The aim of this project was to 1) explore the feasibility of applying a failure modes, effects and criticality analysis (FMECA) in two EDs examining four processes of care (triage, analgesic management, high risk/high users, and referrals made) for patients with SCD, and 2) report the failures of these care processes in each ED.\n Methods:\n A FMECA was conducted of ED SCD patient care at two hospitals. A multidisciplinary group examined each step of four processes. Providers identified failures in each step, and then characterized the frequency, impact, and safeguards, resulting in risk categorization.\nResults:\n Many “high risk” failures existed in both institutions, including a lack of recognition of high-risk or high-user patients and a lack of emphasis on psychosocial referrals. Specific to SCD analgesic management, one setting inconsistently used existing analgesic policies, while the other setting did not have such policies.\nConclusion: \nFMECA facilitated the identification of failures of ED SCD care and has guided quality improvement activities. Interventions can focus on improvements in these specific areas targeting improvements in the delivery and organization of ED SCD care. Improvements should correspond with the forthcoming National Heart, Lung and Blood-sponsored guidelines for treatment of patients with sickle cell disease. [West J Emerg Med. 2014;15(4):446–458.]",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution-NonCommercial  4.0",
        "short_name": "CC BY-NC 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNonCommercial — You may not use the material for commercial purposes.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by-nc/4.0"
    },
    "keywords": [
        {
            "word": "Decision support tool, quality improvement, sickle cell disease, vaso-occlusive crisis, emergency department, pain management, ED-SCANS, patient safety"
        }
    ],
    "section": "Emergency Department Operations",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/2gh264h4",
    "frozenauthors": [
        {
            "first_name": "Victoria",
            "middle_name": "Lynne",
            "last_name": "Thornton",
            "name_suffix": "",
            "institution": "Duke University Medical Center, Division of Emergency Medicine Durham, North Carolina",
            "department": "None"
        },
        {
            "first_name": "Victoria",
            "middle_name": "Lynne",
            "last_name": "Thornton",
            "name_suffix": "",
            "institution": "Duke University Medical Center, Division of Emergency Medicine Durham, North Carolina",
            "department": "None"
        },
        {
            "first_name": "Jane",
            "middle_name": "L.",
            "last_name": "Holl",
            "name_suffix": "",
            "institution": "Northwestern University, Feinberg School of Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois",
            "department": "None"
        },
        {
            "first_name": "David",
            "middle_name": "M",
            "last_name": "Cline",
            "name_suffix": "",
            "institution": "Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina",
            "department": "None"
        },
        {
            "first_name": "Caroline",
            "middle_name": "E",
            "last_name": "Freiermuth",
            "name_suffix": "",
            "institution": "Duke University Medical Center, Division of Emergency Medicine Durham, North Carolina",
            "department": "None"
        },
        {
            "first_name": "Dori",
            "middle_name": "Taylor",
            "last_name": "Sullivan",
            "name_suffix": "",
            "institution": "Duke University Medical Center, Duke School of Nursing, North Carolina",
            "department": "None"
        },
        {
            "first_name": "Paula",
            "middle_name": "",
            "last_name": "Tanabe",
            "name_suffix": "",
            "institution": "Duke University Medical Center, Division of Emergency Medicine Durham, North Carolina",
            "department": "None"
        }
    ],
    "date_submitted": "2013-11-18T18:36:41Z",
    "date_accepted": "2013-11-18T18:36:41Z",
    "date_published": "2014-06-07T00:02:12Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/8043/galley/4650/download/"
        }
    ]
}