Throughput and Disposition Metrics When Using Dsuvia as a Bridging Medication to Decrease Time to Analgesia and Hospital Admissions in Patients With Sickle Cell Disease Vaso-Occlusive Crisis That Present to the Emergency Department

Patients with SCD VOC may present to the ED after oral home medications fail to relieve acute pain. Patients with SCD VOC may require parenteral analgesia for pain relief but, upon arrival to the ED these patients often undergo long wait times until receiving first parenteral medication dose. Oral opioid pain medications are not adequate as most adult patients with SCD and history of SCD VOC have already tried utilizing oral opioids out of the hospital. Intravenous access is challenging in this population with venous scarring or central ports that require sterile access. The need to establish IV access and to, eventually, provide parenteral opioids results in long delays in the time to first dose of drug (time to analgesia) in patients with SCD VOC that present to the ED. Delays in analgesia increase the likelihood of hospital admission in patients with SCD VOC that present to the ED. Patients with SCD VOC that are admitted to the hospital often have a long LOS. A bridge medication or intervention is needed for patients with SCD VOC upon entry into the ED that provides adequate and timely analgesia. In 2020, our ED began utilizing Dsuvia in patients with SCD VOC as a bridging medication. Data has not been collected to specifically examine the impact of Dsuvia use on patient throughput metrics and disposition.

Use of Dsuvia in ED patients with SCD VOC will decrease door to first analgesic time (time to analgesia). Decrease of door to first analgesic time will decrease the overall admission rate for patients with SCD VOC without decreasing patient or staff satisfaction. Use of STL Dsuvia will not lead to an increase in adverse patient safety events. Patients that receive Dsuvia early in the ED encounter may also require a lower overall amount of opioids, represented by morphine milligram equivalents (MME) than patients in a historical control group that did not receive Dsuvia. In addition, this study extends evidence for efficacy of Dsuvia in patients with acute pain but a history of opioid tolerance (unlike prior studies with Dsuvia that excluded patients with opioid tolerance). Since 2020, our ED standard of care for patients with SCD VOC is to utilize Dsuvia as early as possible in the ED course.