A novel approach to reducing admissions for children with sickle cell disease in pain crisis through individualization and standardization in the emergency department

Schefft, Matthew; Swaffar, Caitlan; Newlin, Jennifer; Noda, Cady; Sisler, India

doi:10.1002/pbc.27274

Cited by 22 publications

(16 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…5 Although this study did not show a reduction in admission rate with the use of individualized pain plans, other pediatric studies have. 6 The difference may be due to a difference in data collection periods FDR, False-discovery rate; DM, diabetes mellitus; VTE, venous thromboembolism; LWBS, left without being seen. *Estimate is the exponential of the coefficient estimated from the model.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Use of Individualized Pain Plans in Sickle Cell Patients Presenting to the Emergency Department

Della-Moretta

Delatore²,

Purcell³

et al. 2020

Annals of Emergency Medicine

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

The Effect of Use of Individualized Pain Plans in Sickle Cell Patients Presenting to the Emergency Department

Della-Moretta

Delatore²,

Purcell³

et al. 2020

Annals of Emergency Medicine

View full text Add to dashboard Cite

“…22,27 The enhanced recovery after surgery protocols have been shown to reduce perioperative opioids use, LOS, and perioperative morbidity. 12,13,30,31 In addition, patient education and written guidelines for surgeons have reduced the number of opioids prescribed after surgery. 3,8-10,32,33 Similarly, setting limits on prescription quantities has also had some success in decreasing opioid prescriptions postoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…Although opioid use history was considered, it did not substantially influence the pain control program. In other medical specialties, Schefft et al 31 demonstrated that the presence of an individualized pain plan reduced the admission rates for children with sickle cell disease presenting in vaso-occlusive crisis. Their individualized pain plan was built with consideration of the patient's opioid experiences from prior hospitalizations.…”

Section: Figurementioning

confidence: 99%

Pain Plan Implementation Effect: Analysis of Postoperative Opioid Use, Hospital Length of Stay, and Clinic Resource Utilization for Patients Undergoing Elective Spine Surgery

Rozenfeld

Uppal

Hesselbach

et al. 2022

J Am Acad Orthop Surg

View full text Add to dashboard Cite

Introduction:The Pain Plan was developed collaboratively and implemented a unique systematic approach to reduce opioid usage in elective spine surgery. Methods: This was a retrospective cohort study comparing patients who underwent elective spine surgery before and after Pain Plan implementation. The Pain Plan was implemented on May 1, 2019. The experimental group comprised patients over the subsequent 1-year period with a Pain Plan (n = 319), and the control group comprised patients from the previous year without a Pain Plan (n = 385). Outcome variables include hospital length of stay (LOS), inpatient opioid use, outpatient opioid prescription quantities, number of clinic communication encounters, and communication encounter complexity. Patients were prospectively divided into three surgical invasiveness index subgroups representing small-magnitude, medium-magnitude, and large-magnitude spine surgeries. Results: There was a statistically significant decrease in hospital LOS (P = 0.028), inpatient opioid use (P = 0.001), and the average number of steps per communication encounter (P = 0.010) for Pain Plan patients and a trend toward decreased outpatient opioid prescription quantities (P = 0.052). No difference was observed in patient-reported pain scores. Statistically significant decreases in inpatient opioid use were seen in large-magnitude (50% reduction, P , 0.001) and medium-magnitude surgeries (49% reduction, P , 0.001). For smallmagnitude surgeries, there was no difference (1.7% reduction, P = 0.99). The median LOS for large-magnitude surgeries decreased by 38% (20.5-hour decrease, P , 0.001) and decreased by 34% for medium-magnitude surgeries (17-hour difference, P = 0.055). For small-magnitude surgeries, there was no significant difference (P = 0.734). Outpatient opioid prescription quantities were markedly

show abstract

“…Research has suggested several approaches for reducing avoidable healthcare utilization in patients with SCD, such as the use of individual pain treatment plans when patients present to the ED with a VOC, and shorter time to opiate dosing [ 26 , 43 ]. Shifting care from the reactionary acute setting to proactive disease management provided in the clinic may also reduce avoidable utilization.…”

Section: Discussionmentioning

confidence: 99%

Patterns of healthcare utilization among patients with sickle cell disease hospitalized with pain crises

Rodday

Esham

Savidge

et al. 2020

eJHaem

View full text Add to dashboard Cite

Background Vaso‐occlusive crises (VOC) are the hallmark of sickle cell disease (SCD). Adults experiencing VOC often have high rates of unexpected healthcare utilization. We characterized prior and future healthcare utilization among adults hospitalized with VOC at an urban, academic medical center. Methods We identified 449 VOC hospitalizations among 63 patients from 2013 to 2016. Patients were categorized based on receiving established care at the medical center and prior utilization: (a) not established (n = 21); (b) newly established (n = 10); (c) established with low utilization in past 12 months (<4 VOC hospitalizations) (n = 22); and (d) established with high utilization in past 12 months (≥4 VOC hospitalizations) (n = 10). Patient and hospitalization characteristics and future utilization were compared across categories. Results Median age was 26 years (Q1 = 22, Q3 = 29) and 55.6% were female. Established patients with high prior utilization tended to have higher median pain scores at admission (10, P = .08). Thirty‐day readmissions were highest in established patients with high prior utilization (P = .06), but 30‐day clinic visits were highest in established patients with low prior utilization (P = .08). Adjusted linear regression found that newly established patients (β = −4.6, P < .01) and established patients with low prior utilization (β = −5.6, P < .01) had fewer VOC hospitalizations in the ensuing 12 months than established patients with high prior utilization. Conclusion Among patients with SCD hospitalized for VOC, there was heterogeneity in healthcare utilization, with persistence in utilization over time for some patients. Efforts are needed to shift care from the acute setting to the outpatient clinic, which may lead to improved outcomes.

show abstract

A novel approach to reducing admissions for children with sickle cell disease in pain crisis through individualization and standardization in the emergency department

Abstract: This study presents an effective strategy to reduce admission rate for children with SCD presenting with VOC. Shorter time to second opiate dosing was also associated with reduced risk of admission.

Cited by 22 publications

References 17 publications

The Effect of Use of Individualized Pain Plans in Sickle Cell Patients Presenting to the Emergency Department

The Effect of Use of Individualized Pain Plans in Sickle Cell Patients Presenting to the Emergency Department

Pain Plan Implementation Effect: Analysis of Postoperative Opioid Use, Hospital Length of Stay, and Clinic Resource Utilization for Patients Undergoing Elective Spine Surgery

Patterns of healthcare utilization among patients with sickle cell disease hospitalized with pain crises

Contact Info

Product

Resources

About