Role of effective care plans in reducing admissions for sickle cell patients.

Abstract

156 Background: Adults with sickle cell disease (SCD) vaso-occlusive crisis (VOC) frequently seek care in the emergency department (ED) which often results in hospital admissions. The Hematology-Oncology at Ellis Fischel Cancer Center collaborated with organization’s ED to develop and implement individualized care plans for adults with SCD presenting to the ED with the goal of adequate outpatient management and a reduction in hospital admissions. Methods: Baseline data collected from November 2014 through December 2016 indicated that 108 SCD patients accounted for 195 inpatient hospital admissions, and 40% of all 30-day readmissions for the Hematology-Oncology service line. Further, the average length of stay for patients admitted for SCD crisis was 6.8 days per stay. Medical Director, Oncology Unit Manager, and Performance Improvement Professional collaborated with the ED Medical Director and representatives to develop a disease-specific acute care plan for our adult SCD patient population. The care plan include pathways for lab collection, pain medication regimens, prescription opioid refill policies, a timeline for outpatient follow-up, and criteria for hospital admission. These care pathways were then transitioned to order sets in within the organization’s electronic medical record. Results: Implementation of the SCD care plans resulted in significant improvement in the 30-day readmission rate among the SCD patient population, from 40% to 3%. Further, use the SCD care plans helped reduce the average length of stay for patients admitted with SCD crisis from 6.8 days to 3 days. More importantly, we have been able to sustain this improvement over time. Conclusions: This study clearly demonstrates that collaboration with the ED and development of care plans are key to reducing ED and hospital utilization among patients with SCD, and reducing the average length of stay for SCD patients who require hospitalization for disease management.