A Standardized Clinical Pathway to Decrease Hospital Admissions Among Febrile Children With Sickle Cell Disease.

Area of Science:

• Hematology
• Emergency Medicine
• Quality Improvement

Background:

• Recurrent hospital admissions for sickle cell disease (SCD) significantly impact patient quality of life and healthcare costs.
• Emergency department (ED) evaluations for febrile SCD patients often lead to hospital admission.

Purpose of the Study:

• To implement and evaluate a clinical pathway for the safe discharge of febrile SCD patients from the ED.
• To reduce unnecessary hospital admissions for SCD patients presenting with fever.

Main Methods:

• An interdisciplinary team developed a clinical pathway identifying low-risk febrile SCD patients using historical, clinical, and laboratory criteria.
• An automated electronic notification system was used for planned phone follow-up within 24 hours of ED discharge.
• Pre-implementation trials informed process refinement, followed by post-implementation monitoring of discharge and follow-up rates.

Main Results:

• During the first 9 weeks post-implementation, 84% of eligible febrile SCD patients were discharged from the ED.
• This reduced admission rate was sustained for 3 years.
• 100% of discharged patients had successful phone follow-up within 24 hours, with no identified adverse events.

Conclusions:

• Febrile sickle cell disease patients meeting low-risk criteria can be safely discharged from the emergency department.
• Automated electronic medical record notifications effectively facilitate post-discharge patient follow-up.
• Future efforts should focus on modifiable risk factors to further decrease admissions in this population.