Individualized patient programs including pharmacologic and nonpharmacologic treatments for vaso-occlusive crisis (VOC), a common and painful complication of sickle cell disease (SCD) that leads to frequent patient hospitalizations, could enhance patient well-being and decrease hospitalization and hospital costs, according to research published in Pediatrics.
The goal of the study was to decrease hospital stays for patients with SCD admitted for VOC by 40% over a 5-year period. Number of hospital days was the primary measure, and 30-day readmission rate was the balancing measure.
The multidisciplinary, quality improvement project took place from October 2011 to September 2016. The team developed a VOC management program comprising 9 interventions, including individualized home pain plans, emergency department and inpatient order sets, an inpatient daily schedule, psychoeducation, and a biofeedback program, based on 5 key drivers.
During the study, 248 patients were admitted to the program, 122 of whom were admitted for VOC. Duration of hospitalization decreased by 61% from 59.6 days per month prior to intervention to 23.2 days per month post-intervention (P <.0001), and the average length of stay decreased from 4.78 to 3.84 days (P =.02). Similarly, the 30-day readmission rate decreased from 33.9% to 19.4%. The authors estimated that the overall savings in direct hospital costs were $555,120 per year.
The authors concluded that “a dedicated team effort with simple interventions can have a significant impact on the well-being of a patient population and hospital costs” and “expanding nonpharmacological strategies contributed significantly to the project’s success.”
1. Balsamo L, Shabanova V, Carbonella J, et al. Improving care for sickle cell pain crisis using a multidisciplinary approach [published online February 4, 2019]. Pediatrics. doi:10.1542/peds.2018-2218