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Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
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Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload

Published on: March 14, 2017

Improving care for children with sickle cell disease/acute chest syndrome

Elizabeth A Crabtree1, M Michele Mariscalco, Joy Hesselgrave

  • 1Evidence Based Outcomes Center, Texas Children’s Hospital, Houston, Texas 77030, USA. eacrabtr@texaschildrens.org

Pediatrics
|January 19, 2011
PubMed

Insights

Implementing a clinical practice guideline for children with sickle cell disease (SCD) and acute chest syndrome (ACS) significantly improved patient outcomes. The guideline led to shorter hospital stays and reduced costs for pediatric SCD patients.

Area of Science:

  • Pediatric Hematology
  • Clinical Quality Improvement
  • Evidence-Based Medicine

Background:

  • Acute Chest Syndrome (ACS) is a major cause of mortality and hospitalization in children with Sickle Cell Disease (SCD).
  • An evidence-based guideline was established in 2008 to standardize ACS/SCD care, but its use became inconsistent by 2009.
  • An implementation program was developed to address inconsistent guideline adherence and improve clinical outcomes.

Purpose of the Study:

  • To evaluate the impact of a clinical practice guideline for pediatric patients with SCD and ACS on clinical outcomes.
  • To assess the effectiveness of a developed implementation program for the ACS/SCD guideline.

Main Methods:

  • A quality-improvement project evaluated 139 pediatric patients with SCD before and after the implementation program.
  • Key outcomes measured included average length of stay, exchange transfusion rates, cost per admission, and documentation of respiratory scores and pulmonary interventions.

Main Results:

  • Average length of stay decreased from 5.8 to 4.1 days (P = .033).
  • No patients required exchange transfusions post-implementation.
  • Average cost per admission decreased from $30,359 to $22,368.
  • Documentation of clinical respiratory score increased by 44.5% (P < .001), and pulmonary interventions increased by 27.1% (P < .001).

Conclusions:

  • The implementation of the ACS/SCD clinical practice guideline significantly improved clinical outcomes for pediatric patients with SCD.
  • The quality improvement initiative demonstrated success in standardizing care and enhancing patient management for ACS in children with SCD.
Abstract

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