Improving Care for Sickle Cell Pain Crisis Using a Multidisciplinary Approach

Abstract

OBJECTIVES: Frequent hospitalizations for sickle cell disease (SCD) vaso-occlusive crises (VOCs) are associated with school absenteeism, emotional distress, and financial hardships. Our goal was to decrease hospital days for VOC admissions by 40% over a 5-year period. METHODS: From October 2011 to September 2016, a multidisciplinary quality-improvement project was conducted with a plan-do-study-act methodology. Five key drivers were identified and 9 interventions implemented. Interventions included individualized home pain plans, emergency department and inpatient order sets, an inpatient daily schedule, psychoeducation, and a biofeedback program. High users (≥4 admissions per year) received an individualized SCD plan and assigned mental health provider. We expanded the high-use group to include at-risk patients (3 admissions per year). Data were analyzed for patients ages 0 to 21 years admitted for VOC. Hospital days were the primary measure; the 30-day readmission rate was the balancing measure. RESULTS: A total of 216 SCD pediatric patients were managed in 2011 with a 14% increase over 5 years. A total of 122 patients were admitted for VOC. Hospital days decreased by 61% from 59.6 days per month in the preintervention period to 23.2 days per month in the postintervention period (P < .0001). Length of stay decreased from 4.78 (SD = 4.08) to 3.84 days (SD = 2.10; P = .02). Among high users, hospital days decreased from 35.4 to 15.5 days per month. The thirty-day readmission rate decreased from 33.9% to 19.4%. Overall savings in direct hospital costs per year were $555 120. CONCLUSIONS: A dedicated team effort with simple interventions can have a significant impact on the well-being of a patient population and hospital costs.

Emergency Department Health Care Utilization and Opioid Administration Among Pediatric Patients With Sickle Cell Vasoocclusive Pain Crisis and Coexisting Mental Health Illness

“…16 Through psychoeducation and a biofeedback program, both of which provide therapeutic support and reinforce coping skills, a quality improvement project has demonstrated that hospital LOS and hospital costs can be significantly decreased in SCD patients using a multidisciplinary approach, which included both of these interventions. 17 Patients with SCD are at increased risk for MH conditions given the chronicity of their illness and the distress from acute and/or chronic pain with VOC. Among adult patients with SCD, the prevalence of depressive disorders is estimated to be 5 times higher than in the general population.…”

<p>Depression and Anxiety as Moderators of the Pain-Social Functioning Relationship in Youth with Sickle Cell Disease</p>

“…It builds on previous work supporting the need for multidisciplinary approaches to care for youth with SCD who experience pain. 33,34 It also provides support for the applicability of Valrie's biopsychosocial model of pediatric pain 14 for understanding the experiences of youth with SCD, and rationale for future studies to investigate the possible moderating role of depression and anxiety symptoms on other functional outcomes in youth with SCD and other pediatric pain populations.…”

Physician Perspectives on Acupuncture Use in the Pediatric Emergency Department

“…Additional QI projects have demonstrated improved use of other specific pediatric pain management strategies after their inclusion in standard order sets. 19,20 Addressing the issue of time as a barrier may also facilitate acupuncture implementation. Similar to a study of acupuncture implementation in an adult health care setting, 16 our participants discussed that the busy and unpredictable nature of the ED was a barrier to acupuncture usage.…”

“…Jain et al 18 found that the addition of specific orders to provider order sets as part of a QI project contributed to successful implementation of jet injection lidocaine for pediatric pain management. Additional QI projects have demonstrated improved use of other specific pediatric pain management strategies after their inclusion in standard order sets 19,20 …”