Improving Care for Sickle Cell Pain Crisis Using a Multidisciplinary Approach.

Area of Science:

• Pediatric Hematology
• Quality Improvement Science
• Healthcare Management

Background:

• Frequent hospitalizations for sickle cell disease (SCD) vaso-occlusive crises (VOCs) lead to significant patient and family burdens.
• These burdens include school absenteeism, emotional distress, and financial hardships.
• Reducing VOC admissions is a critical healthcare objective.

Purpose of the Study:

• To decrease hospital days for VOC admissions by 40% over a 5-year period.
• To improve the overall well-being of pediatric patients with SCD.
• To reduce direct hospital costs associated with VOC admissions.

Main Methods:

• A multidisciplinary quality-improvement project utilized a plan-do-study-act methodology.
• Key interventions included individualized home pain plans, standardized order sets, psychoeducation, and a biofeedback program.
• Special attention was given to high-use patients (≥4 admissions/year) and at-risk patients (3 admissions/year).

Main Results:

• Hospital days for VOC admissions decreased by 61% post-intervention (59.6 to 23.2 days/month).
• Average length of stay decreased from 4.78 to 3.84 days.
• The 30-day readmission rate decreased from 33.9% to 19.4%, with annual cost savings of $555,120.

Conclusions:

• A dedicated team and simple interventions can significantly impact patient well-being.
• Quality improvement initiatives can effectively reduce hospitalizations for SCD VOCs.
• This approach demonstrates a positive impact on both patient outcomes and hospital finances.