Evaluating the American Society of Hematology Quality Measure on Timeliness of Analgesics for Sickle Cell Disease Pain Crisis Open Access

• We evaluated the median time to the receipt of first pain medication for sickle cell pain in the emergency department across 225 sites.

• The median times to first pain medication ranged from 30 to 250 minutes, and 86% of the sites had the median time greater than 60 minutes.

We leveraged multi-site electronic health records data from Epic's Cosmos research platform to analyze ED encounters for SCD VOE from 1/1/2019, to 12/31/2024, with the administration of at least one 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 versus non-opioid) and administration route (oral versus parenteral) and compared the values across site-level characteristics: pediatric versus 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 higher than 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% CI: 19.5, 86.5) lower than adult sites (58 versus 83 minutes, p = 0.001); encounter volume did not consistently influence the site's performance. The vast majority of sites performed poorly on the measure. These baseline data suggest implementing the ASH-proposed quality measure could stimulate improvements in ED pain management.