Aiming to Reduce Admissions and Also Re-Admissions in Pediatric Sickle Cell Disease: A Single Institutional Experience with Six Interventions

BACKGROUND AND OBJECTIVES

Sickle Cell disease is an inherited blood disorder of the hemoglobin beta-globin protein in the red blood cells which results in significant risk for hospitalization. Since over 100,000 people in the USA have Sickle Cell Disease and recurrent hospitalizations occur; this constitutes a significant disease burden that are not only costly, but also contribute to loss of income, learned helplessness, additional immense morbidities and psychosocial stressors.

Readmission within 30 days after hospitalization for sickle cell crises was developed at the National Association of Children's Hospitals (NACHRI) as a measurable benchmark to improve hospital quality. The NACHRI, multi state study of sickle cell disease care utilization found an overall readmission rate of 33.4% with lower rates in children (12.8% in children age1-9 and 23.4% for patients ages 10-17).

At our institution, we implemented several interventions to reduce the readmission rate for sickle cell pain crises and will share results and insights.

INTERVENTIONS

The following interventions were employed: a) services of a sickle cell coordinator to co-ordinate clinic visits and patient care b) provide additional standardized teaching on sickle cell care via direct interactions with caregivers, provision of educational materials and organization of a sickle cell awareness conference c) verbal discussions to improve understanding and compliance with a written sickle cell action plan, d) obtaining more frequent parental approval for hydroxyurea therapy, e) increasing tracking immunization rates (influenza), and f) 24hr/72hr discharge telephone call.

The sickle cell team comprising of physicians, nurse practitioners, care coordinator, nurses and social worker actively participated in implementing these steps, and majority of the interventions took place in the outpatient setting.

RESULTS

We reviewed sickle cell admissions and readmissions in 2014 and 2015 in patient's age 0-26 years. Mean age of patients was16.8year (N= 14 Standard deviation = 8.04).

Pre-intervention in 2014 there were 91 admissions with 14/91 re-admissions (15.4%). After beginning implementation of interventions in 2015 there were not only 59% fewer admissions (63), but also 58% fewer readmissions (6 re admit/63 discharges = 9.5%). Thus our interventions affected both admission rate and readmission rates.

CONCLUSION

Sickle cell admissions and subsequent readmissions continue to be a major challenge in successful management of young people with sickle cell disease. Our interventions may help abate some of the hospitalizations and re-admissions as shown by an approximately 40% reduction rate. Although there is undoubtedly much room for additional progress in this area, we have made a good start towards improving our sickle cell population's health.