13 Impact of implementation of ‘sickle cell disease acute painful crisis clinical pathway’ at KFAFH on reducing the number of ER visits, admission, readmission rates, opioid consumption, and cost

Abstract

Background Vaso-occlusive crisis is the most common complication of sickle cell disease (SCD) in adults, which is the primary reason why these patients seek medical care in emergency departments (EDs). We noticed increasing numbers of ED visits with a painful crisis together with increasing consumption of opioids. Therefore, a clinical pathway for the management of SCD acute painful crisis has been initiated at KFAFH in Jeddah. The main objectives of this clinical pathway management were to unify practice, standardize care, and promote judicious use of opioids at KFAFH. The aims of this study were: To reduce the rate of ER visits per patient by more than 50% within 1 year. To decrease the rate of admissions per patient and readmission rates by more than 30% and 40%, respectively, within 1 year. To reduce the consumption of meperidine and tramadol by more than 25% and 40%, respectively, within 1 year as a secondary outcome. Methods A clinical pathway for the management of SCD acute painful crisis has been initiated at KFAFH in Jeddah. A total of 374 patients with SCD (aged 12 years or older with isolated painful crisis) was identified by KFAFH Emergency Department registration data. The primary source of patient information was the patient file, ED registration, and chart review for 1 year before (May 2016 to April 2017) implementation of the clinical pathway and 1 year after (May 2017 to April 2018) implementation of the clinical pathway. Results ED visits: The annual rate of ED visits per patient dropped by 75.55% (45 versus 11.5). There was a progressive reduction in the frequency of ED visits over the year. Admission rate: The rate of admissions per patient dropped by 41.87%. Readmission rate: The readmission rate declined by 54.51%. Opioid consumption: Consumption of opioids decreased by 33% for meperidine 100 mg and by 41.6% for meperidine 50 mg. Consumption significantly decreased by 54% for tramadol capsules and by 33% for tramadol injection. Cost saving: The cost saved after implementation of the clinical pathway is more than 410,709 SR. Conclusion Proper pain management for patients with SCD leads to a significant decrease in ED visits, and reduces hospital admissions and readmission rates. Consequently, more than 400,000 SR was saved after the implementation of the pathway. We believe that physicians, nurses, and patient education sessions played a critical role in the success of the clinical pathway.