Day hospital versus inpatient management of uncomplicated vaso‐occlusive crises in children with sickle cell disease

Abstract

We conclude that a dedicated DH facility has the potential to provide efficient and timely management of uncomplicated VOCs through reduction of length of stay. This delivery care system may be particularly relevant for children who are significantly impacted by inpatient hospitalization.

Emergency Department Visits Made by Patients with Sickle Cell Disease

“…In addition, pain management care through SCD day hospitals in outpatient settings can possibly divert individuals with SCD from emergency departments. [10][11][12] Routine care among children with SCD may be less than optimal. A study conducted among children in a Medicaid and SCHIP managed care health plan in Texas reported that approximately 60% of children with SCD averaged one well child-care visit per year, not significantly different from the number for other children in the plan.…”

“…Research indicates that SCD day hospitals may be an effective mechanism for treatment of uncomplicated vaso-occlusive crisis. 11,12 An important complication of SCD is the occurrence of unpredictable episodes of pain that result from vaso-occlusion. In this study's findings, pain was cited by the patient as a reason for the visit in approximately 78% of the emergency department visits by patients with SCD.…”

Current Management of Sickle Cell Anemia

“…Historically, the most painful VOEs have been evaluated and treated in the local emergency room, but given the relative lack of sickle cell knowledge and familiarity among some healthcare providers, such evaluations have delays in initiating appropriate analgesia, poor pain control, and a high rate of hospital admission. A sickle cell day hospital approach, which features staffing by experienced sickle cell providers, is increasingly used and results in improved pain management, better patient satisfaction, and decreased rates of hospitalization for both adults and children with SCA (Benjamin et al 2000;Raphael et al 2008). …”

Research design creates ambiguity related to efficacy of sickle cell, chronic disease specialty clinic

“…The most relevant article was by Grosse et 4 who compared day hospitalization versus inpatient care for children with SCD, were reviewed. Raphael found a reduction in hospitalization days in the pediatric population.…”