Related Experiment Videos
Multi-modal intervention and prospective implementation of standardized sickle cell pain admission orders reduces
Melissa J Frei-Jones1, Joshua J Field, Michael R DeBaun
1Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA.
Insights
A new intervention significantly reduced 30-day hospital readmissions for children with sickle cell disease (SCD) pain. Provider education was key to this improvement in pediatric SCD care.
Area of Science:
- Pediatric Hematology
- Quality Improvement in Healthcare
- Clinical Interventions
Background:
- 30-day hospital readmission rates are a key quality indicator for pediatric sickle cell disease (SCD).
- Risk factors for readmission in children with SCD pain have been identified.
- A multi-modal intervention was developed to address these readmissions.
Purpose of the Study:
- To evaluate the effectiveness of a multi-modal intervention in reducing 30-day hospital readmission rates for children with SCD and pain.
- To assess the impact of standardized orders, provider education, and patient/caregiver education on readmission rates.
Main Methods:
- A before-and-after study design was employed.
- The intervention included standardized SCD-pain admission orders, monthly in-service education for physicians, and continuous patient/caregiver education.
- Readmission rates were compared before and after intervention implementation.
Main Results:
- The intervention group had 89 admissions (68 individuals) compared to 85 admissions (56 individuals) in the control group.
- Standardized orders were utilized in 93% of eligible admissions during the intervention period.
- The 30-day readmission rate decreased from 28% in the control group to 11% in the intervention group (P = 0.007).
Conclusions:
- The multi-modal intervention effectively reduced 30-day hospital readmissions for pediatric patients with SCD and pain.
- Provider education emerged as the most critical component of the intervention's success.
Introduction:
The National Association of Children's Hospitals (NACHRI) and the Centers for Medicare and Medicaid Services (CMS) recently introduced 30-day hospital readmission rate as a quality care indicator in children with sickle cell disease (SCD). Based on previous research identifying risk factors for 30-day readmission in our patient population, we designed and implemented a multi-modal intervention to reduce 30-day readmission rate in children with SCD and pain.
Methods:
A before-and-after study design was performed to evaluate an intervention containing three components: (1) standardized SCD-pain admission orders; (2) monthly SCD-pain in-service for house physicians for the first 6-months; and (3) continuous patient/caregiver education. Following order implementation, we prospectively collected data on all children admitted for SCD-pain over a 6-month period. We compared the 30-day readmission rate after the intervention to the rate during the same 6-month interval in the previous calendar year prior to the availability of pre-specified SCD-pain orders.
Results:
A total of 89 admissions, in 68 individuals, were eligible for the standardized orders during the prospective time period and were compared to 85 admissions in 56 individuals during the control period. Pre-specified SCD-pain orders were used in 93% of eligible admissions during the intervention. Readmission rate within 30 days was lower for the intervention cohort than the control cohort, 11% (10/89) versus 28% (24/85), P = 0.007, 95% CI 0.1-0.7.
Conclusions:
A multi-modal intervention was successful in decreasing 30-day hospital readmission rate for children with SCD and pain. Provider education was the most important component of the multi-modal intervention.
Related Concept Videos
01:15Methods of Documentation VI: Case Management Model
For example, a patient with a chronic illness...
01:14SBAR II: Application of SBAR
SBAR Report from a Nurse to a Health Care Provider
S: "Hello, Dr. Smith. This is Jane, RN, from the Med Surg unit. I am calling to tell you about Ms. White in Room 210, who is experiencing increased pain and redness at her incision site. Her recent...
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:27Nursing Clinical Information System
A Nursing Clinical Information System (NCIS) is a specialized type of healthcare information system tailored to meet the unique needs of nursing practice. It incorporates the principles of nursing informatics to streamline information management and improve the quality of care delivery.
Critical attributes of NCIS include:
01:26Peripheral Artery Disease IV: Nursing Management
01:27Peripheral Artery Disease III: Interprofessional Care