source: The Journal of Pain

year: 2015

authors: H. Williams, P. Tanabe

The most common symptom for persons with sickle cell disease (SCD) is severe pain from vaso-occlusive crisis (VOC), which often requires treatment in the emergency department (ED). Many patients with SCD experience numerous unmet psychological and social complications (e.g., depression, anxiety, transportation challenges) which can contribute to increased pain. These needs have not been explored among a sample of ED patients experiencing a VOC in an ED. The objective of this quality improvement (QI) project was to implement a social worker screening of all adults with SCD during an ED visit and explore psychological and social needs.

The QI team developed a 15-item screening tool to be administered by the ED social worker. The tool assesses for self-reported anxiety and depression, transportation barriers, prescriptions barriers, assessment of missed days of work, and other unmet needs. Upon arrival to the ED, an automatic page to the ED social worker is sent. Over a 12-month period 134 screens were conducted. Depression and anxiety were reported during 31% and 22% of all screenings respectively.

During all screenings patients reported the following barriers (frequencies): transportation to clinic appointments (38%), having to wait for a ride to the ED (29%), obtaining prescriptions (33%) and being unable to afford co-pay or prescriptions (26%). Additional barriers to care included limited Medicaid options, and communication concerns with ED staff. Implementation of a social worker screen in the ED is feasible, and there was overwhelming support of the process by patients and social workers. An opportunity exists for ED social workers or case managers to identify and refer patients to healthcare services designed to meet the unmet needs of persons with SCD who experience a VOC and an ED visit. We believe these needs may contribute to increased pain and ED use; research is necessary to explore this hypothesis.

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