Improving Care for Sickle Cell Pain Crisis Using a Multidisciplinary Approach

• Published in: Pediatrics (Evanston)
• Main Authors: Balsamo, Lyn, Shabanova, Veronika, Carbonella, Judith, Szondy, Mary V, Kalbfeld, Karen, Thomas, Donna-Ann, Santucci, Karen, Grossman, Matthew, Pashankar, Farzana
• Format: Journal Article
• Language: English
• Published: United States 01.05.2019
• ISSN: 1098-4275
• DOI: 10.1542/peds.2018-2218

Frequent hospitalizations for sickle cell disease (SCD) vaso-occlusive crises (VOCs) are associated with school absenteeism, emotional distress, and financial hardships. Our goal was to decrease hospital days for VOC admissions by 40% over a 5-year period. From October 2011 to September 2016, a multidisciplinary quality-improvement project was conducted with a plan-do-study-act methodology. Five key drivers were identified and 9 interventions implemented. Interventions included individualized home pain plans, emergency department and inpatient order sets, an inpatient daily schedule, psychoeducation, and a biofeedback program. High users (≥4 admissions per year) received an individualized SCD plan and assigned mental health provider. We expanded the high-use group to include at-risk patients (3 admissions per year). Data were analyzed for patients ages 0 to 21 years admitted for VOC. Hospital days were the primary measure; the 30-day readmission rate was the balancing measure. A total of 216 SCD pediatric patients were managed in 2011 with a 14% increase over 5 years. A total of 122 patients were admitted for VOC. Hospital days decreased by 61% from 59.6 days per month in the preintervention period to 23.2 days per month in the postintervention period ( < .0001). Length of stay decreased from 4.78 (SD = 4.08) to 3.84 days (SD = 2.10; = .02). Among high users, hospital days decreased from 35.4 to 15.5 days per month. The thirty-day readmission rate decreased from 33.9% to 19.4%. Overall savings in direct hospital costs per year were $555 120. A dedicated team effort with simple interventions can have a significant impact on the well-being of a patient population and hospital costs.