Structured Telephone Follow-up Research Articles

Design of a national patient-centred clinical pathway for sepsis in Sweden

Background The World Health Organization has adopted a resolution on sepsis and urged member states to develop national processes to improve sepsis care. In Sweden, sepsis was selected as one of the ten first diagnoses to be addressed, when the Swedish government in 2019 allocated funds for patient-centred clinical pathways in healthcare. A national multidisciplinary working group, including a patient representative, was appointed to develop the patient-centred clinical pathway for sepsis. Methods The working group mapped challenges and needs surrounding sepsis care and included a survey sent to all emergency departments (ED) in Sweden, and then designed a patient-centred clinical pathway for sepsis. Results The working group decided to focus on the following four areas: (1) sepsis alert for early detection and management optimisation for the most severely ill sepsis patients in the ED; (2) accurate sepsis diagnosis coding; (3) structured information to patients at discharge after sepsis care and (4) structured telephone follow-up after sepsis care. A health-economic analysis indicated that the implementation of the clinical pathway for sepsis will most likely not drive costs. An important aspect of the clinical pathway is implementing continuous monitoring of performance and process indicators. A national working group is currently building up such a system for monitoring, focusing on extraction of this information from the electronic health records systems. Conclusion A national patient-centred clinical pathway for sepsis has been developed and is currently being implemented in Swedish healthcare. We believe that the clinical pathway and the accompanying monitoring will provide a more efficient and equal sepsis care and improved possibilities to monitor and further develop sepsis care in Sweden.

Early Hospital Discharge Following PCI for Patients With STEMI

BackgroundRegional heart attack services have improved clinical outcomes following ST-segment elevation myocardial infarction (STEMI) by facilitating early reperfusion by primary percutaneous coronary intervention (PCI). Early discharge after primary PCI is welcomed by patients and increases efficiency of health care. ObjectivesThis study aimed to assess the safety and feasibility of a novel early hospital discharge pathway for low-risk STEMI patients. MethodsBetween March 2020 and June 2021, 600 patients who were deemed at low risk for early major adverse cardiovascular events (MACE) were selected for inclusion in the pathway and were successfully discharged in <48 hours. Patients were reviewed by a structured telephone follow-up at 48 hours after discharge by a cardiac rehabilitation nurse and underwent a virtual follow-up at 2, 6, and 8 weeks and at 3 months. ResultsThe median length of hospital stay was 24.6 hours (interquartile range [IQR]: 22.7-30.0 hours) (prepathway median: 65.9 hours [IQR: 48.1-120.2 hours]). After discharge, all patients were contacted, with none lost to follow-up. During median follow-up of 271 days (IQR: 88-318 days), there were 2 deaths (0.33%), both caused by coronavirus disease 2019 (>30 days after discharge), with 0% cardiovascular mortality and MACE rates of 1.2%. This finding compared favorably with a historical group of 700 patients meeting pathway criteria who remained in the hospital for >48 hours (>48-hour control group) (mortality, 0.7%; MACE, 1.9%) both in unadjusted and propensity-matched analyses. ConclusionsSelected low-risk patients can be discharged safely following successful primary PCI by using a pathway that is supported by a structured, multidisciplinary virtual follow-up schedule.

Robotic surgery can be safely performed for patients and healthcare workers during COVID-19 pandemic.

ObjectivesTo investigate the safety of robotic surgery during COVID‐19 pandemic concerning new‐acquired COVID‐19 infections for patients and healthcare workers.PatientsWe performed a retrospective single‐centre cohort study of patients undergoing robotic surgery in initial period of COVID‐19 pandemic. Patients and healthcare workers COVID‐19 infection status was assessed by structured telephone follow‐up and/or repeated nasopharyngeal swabs.ResultsAfter 61 robotic surgeries (93,5% cancer surgery), one patient (1.6%) had COVID‐19 infection. Sixty healthcare workers cumulatively exposed to 1187 h of robotic surgery had no infection. One patient with postoperative proof of SARS‐CoV‐2 had complete recovery. After this potentially contagious robotic surgery, eight healthcare workers had no COVID‐19 infection after follow‐up with each three nasopharyngeal swabs.ConclusionsEarly clinical experience of robotic surgery during COVID‐19 pandemic shows that robotic surgery can be safely performed for patients and healthcare workers. Despite our results we recommend elective surgery only for verified COVID‐19 negative patients.

Patient and lay carer education for preventing pressure ulceration in at-risk populations.

Patient and lay carer education for preventing pressure ulceration in at-risk populations.

Skills Required in the Care of Cancer Patients Who Undergo Surgery in the Hospital-Home Transition

It is essential to recognize what care is required by patients undergoing surgery in the transition from hospital to home to provide guidance for plans for release and follow-up and to achieve patient adherence to these plans. The objective of this study is to describe the skills required for the care of cancer patients who undergo surgery after hospital discharge. An exploratory-type descriptive approach was adopted, including 290 cancer patients who underwent surgery at a reference center in Bogotá, Colombia. Hospital discharge was followed by 4 weeks of telephone follow-up to investigate the skills required for care on the basis of the CUIDAR tool. The participants had a mean age of 59.3 years, with the majority being female and having low levels of education. The most prevalent type of cancer found was breast cancer, followed by colon and rectal, prostate, stomach, cervical, lung, and ovarian cancer. The first follow-up identified needs for care in most of the CUIDAR dimensions, predominantly instrumentation, knowledge, and anticipation. The fourth follow-up, which found reduced needs, focused on knowledge of diet and eating, physical activity, the management of sadness and anxiety, a permanent telephone hotline, and sharing with loved ones. Cancer patients who underwent surgery require skills for at-home care that need to be addressed in hospital discharge programs and with structured telephone follow-up. Telephone follow-up interventions need to be consolidated in hospital release or hospital discharge programs that address these care needs.

Collaboration between the intensive care unit and organ donation agency to achieve routine consideration of organ donation and comprehensive bereavement follow-up: an improvement project in a quaternary Australian hospital.

Objective Routine family follow-up after bereavement in the intensive care unit (ICU) and routine consideration of organ and tissue donation at end of life are both integral to good health care delivery, yet neither is widely achieved. This study evaluated an initiative to efficiently deliver these outcomes in an Australian setting through a novel collaboration between DonateLife South Australia (DLSA) and the ICU of the Royal Adelaide Hospital. Methods A Plan-Do-Study-Act method of quality improvement was used in the Royal Adelaide Hospital ICU between February 2018 and February 2019. The ICU clinical team identified adult patients and family members at medical consensus of end of life to donation specialist nursing coordinators, who assessed potential for donation and enrolled patients and family members into a bereavement follow-up program. After death, family members received bereavement information and details of a structured telephone follow-up conversation that took place 6-8 weeks later. Results Of 241 deaths, 216 were enrolled in the project. Follow-up telephone calls were completed with 124 of 201 (62%) family members, with 77 (38%) family members not contactable. Follow-up telephone interviews yielded practical suggestions to improve end-of-life care. Donation was considered in all patients enrolled in the project, and referral through DLSA increased from 24% to 90% of all ICU deaths. Associated with the collaborative initiative, consent to organ donation recorded a 63% increase on the 10-year average (from 19 to 31 donors). Corneal donation referral increased by 625%. The initiative required an additional 0.4 full-time equivalent registered nurse. Family members valued the opportunity to debrief their experience. Conclusions Collaboration between DLSA and the Royal Adelaide Hospital ICU achieved universal consideration of organ donation and high rates of structured bereavement follow-up. Follow-up calls were valued with areas for improvement identified. What is known about this topic? Death in the ICU is associated with significant psychopathology among bereaved family members, and bereavement follow-up is widely recommended. Opportunities to consider organ and tissue donation are commonly missed due to lack of consideration at end of life. What does this paper add? Collaboratively exploring donation and performing bereavement follow-up is feasible with a minimal added resource. Such comprehensive approach to good end-of-life care helps identify aspects of care that could be improved and is associated with an increase in organ and tissue donation rates. What are the implications for practitioners? Collaboration between the ICU and DonateLife achieved mutually beneficial outcomes of understanding the end-of-life experience for family members and timely consideration of organ and tissue donation. This timely consideration potentially identified some missed organ donors and then allowed family members to give feedback on their experience.

ANMCO POSITION PAPER: The role of cardiology in the management of the health needs in the post-Covid-19 era.

At the end of 2019 a new Coronavirus appeared in China and, from there, it spread to the rest of the world. On 24th May, 2020, the confirmed cases in the world were more than 5 million and the deaths almost 350.000. At the end of May, Italy reported more than 27.000 cases among healthcare professionals and 163 deaths among physicians. The National Health Systems from almost all over the world, including Italy’s, were unprepared for this pandemic, and this generated important consequences of organizational nature. All elective and urgent specialized activities were completely reorganized, and many hospital units were partially or completely converted to the care of the COVID-19 patients. A significant reduction in hospital admissions for acute heart disease were recorded during the SARS-CoV-2 pandemic and, in order to gradually resume hospital activities, the Italian National Phase 2 Plan for the partial recovery of activities, must necessarily be associated with a Phase 2 Health Plan. In regards to the cardiac outpatient activities we need to identify short term goals, i.e. reschedule the suspended outpatient activities, revise the waiting lists, review the ‘timings’ of the bookings. This will reduce the number of available examinations compared to the pre-Covid-19 era. The GP’s collaboration could represent an important resource, a structured telephone follow-up plan is advisable with the nursing staff’s involvement. It is equally important to set medium-long term goals, the pandemic could be an appropriate moment for making a virtue of necessity. It is time to reason on prescriptive appropriateness, telemedicine implementation intended as integration to the traditional management. It is time to restructure the cardiological units related to the issue of structural adjustment to the needs for functional isolation. Moreover, the creation of ‘grey zones’ with multidisciplinary management according to the intensity of care levels seems to be necessary as well as the identification of Covid dedicated cardiologies. Finally, the pandemic could represent the opportunity for a permanent renovation of the cardiological and territorial medicine activities.

Adherence of older emergency department patients to community-based specialized geriatric services.

Our objective was to determine emergency department (ED) patient adherence to outpatient specialized geriatric services (SGS) following ED evaluation by the geriatric emergency management (GEM) nurse, and identify barriers and facilitators to attendance. We conducted a prospective cohort study at two academic EDs between July and December 2016, enrolling a convenience sample of patients ≥ 65 years, seen by a GEM nurse, referred to outpatient SGS, and consented to study participation. We completed a chart review and a structured telephone follow-up at 6 weeks. Descriptive statistics were used. We enrolled 103/285 eligible patients (86 eligible but not enrolled, 86 declined specialized geriatric referrals, and 10 declined study participation). Patients were mean age of 83.1 years, 59.2% female, and 73.2% cognitively impaired. Reasons for referral included mobility (86.4%), cognition (56.3%), pain (38.8%), mood (35.0%), medications (33.0%), and nutrition (31.1%). Referrals were to Geriatric Day Hospital (GDH) programs (50.5%), geriatric outreach (26.2%), falls clinic (12.6%), and geriatric psychiatry (8.7%). Adherence with follow-up was 59.2%. Barriers to attendance included patient did not feel SGS were needed (52.1%), inability to recall GEM consultation (53.4%), and dependence on family for transportation (72.6%). Home-based assessments had the highest adherence (81.5%). Adherence of older ED patients referred by the GEM team to SGS is suboptimal, and a large proportion of patients decline these referrals in the ED. Future work should examine the efficacy of home-based assessments in a larger confirmatory setting and focus on interventions to increase referral acceptance and address barriers to attendance.

Impact of telephone follow-up and 24/7 hotline on 30-day readmission rates following aortic valve replacement -A randomized controlled trial

BackgroundThirty-day all-cause readmissions are high after aortic valve replacement (AVR). We aimed to assess the effectiveness of a structured telephone follow-up (TFU) and a 24/7 hotline on reducing 30-day all-cause readmission (30-DACR) after AVR, on reducing symptoms of anxiety and depression and on improving perceived health state. MethodsA prospective randomized controlled trial was conducted. Patients (n = 288) were randomly allocated to either post-discharge usual care or to care that provided TFU and access to a 24/7 hotline after AVR. Ancillary endpoints were time-to-event (readmission), proportion of avoidable versus unavoidable readmissions after AVR, and predictors of 30-DACR after AVR. Results30-DACR was 22.3%. The structured TFU and 24/7 hotline intervention failed to reduce 30-DACR rates after AVR (P = 0.274). Symptoms of anxiety were significantly reduced 30 days after surgery (P = 0.031), an effect that did not persist one year after surgery (P = 0.108). Most readmissions occurred before 15 days post-discharge, and 75% of them were deemed to be unavoidable. Pleural drainage before hospital discharge (P = 0.027) and symptoms of anxiety before surgery (P = 0.003) were predictors of 30-DACR after AVR. ConclusionThe TFU and 24/7 hotline had no effect on reducing 30-DACR after AVR. However, we did measure reduced symptoms of anxiety the first month after AVR. Anxiety reduction appeared to be an important target for intervention, because we found it to be a risk factor for readmission. Future research should focus on the effectiveness of interventions to prevent avoidable unplanned readmissions.Trial registration: ClinicalTrial.gov, NCT02522663.

Structured Goal Planning and Supportive Telephone Follow-up in Rheumatology Care: Results From a Pragmatic, Stepped-Wedge, Cluster-Randomized Trial.

To evaluate patient-reported health effects of an add-on structured goal-planning and supportive telephone follow-up rehabilitation program compared with traditional rehabilitation programs in patients with rheumatic diseases. In this pragmatic stepped-wedge, cluster-randomized, controlled trial, 389 patients with rheumatic diseases recruited from 6 rehabilitation centers received either traditional rehabilitation or traditional rehabilitation extended with an add-on program tailored to individual needs. The add-on program comprised a self-management booklet, motivational interviewing in structured individualized goal planning, and 4 supportive follow-up phone calls after discharge. Data were collected by questionnaires on admission and discharge from rehabilitation stay, and at 6 months and 12 months after discharge. The primary outcome was health-related quality of life (HRQoL) measured by the Patient Generated Index (range 0-100, where 0 = low). Secondary outcomes included patient-reported health status, self-efficacy, pain, fatigue, global disease activity, and motivation for change. The main statistical analysis was a linear repeated measures mixed model performed on the intent-to-treat population using all available data. A significant treatment effect of the add-on intervention on HRQoL was found on discharge (mean difference 3.32 [95% confidence interval 0.27, 6.37]; P = 0.03). No significant between-group differences were found after 6 or 12 months. Both groups showed positive changes in HRQoL following rehabilitation, which gradually declined, although the values remained at higher levels after 6 and 12 months compared with baseline values. The add-on program enhanced the short-term effect of rehabilitation with respect to patient-specific HRQoL, but it did not prolong the effect as intended.

Reducing the risk of readmission and death after hospital discharge using a predictive model

Introduction: Patient readmission represents a problem, given its impact on their quality of life and for the system, given the associated costs. The transition between hospital and primary care is a milestone associated with readmission. A high rate of readmission may be associated with poor health care provision and no ideal coordination between health care levels. Recently, various predictive models of readmission have been developed. One of these, the LACE index, has been developed and validated for the prediction of readmission and death within 30 days after hospital discharge. This easy-to-use index has been tested in different populations, providing inconclusive results. It has been recommended that it should first be validated in each target population before use. Interventions designed to ensure continuity of care between different levels of care could be effective in reducing the rate of readmission. It remains unclear which of them are the most effective. Objective: To validate a clinical prediction tool for hospital readmission and death to identify patients at high risk of them and to develop an intervention to reduce readmission and mortality. Design: We elaborated a predictive model based on the LACE index using data from patients discharged from hospital between February and March 2013 in two health areas, Bidasoa and Uribe Basque Country, Spain. We validated the model with a retrospective sample from 2012. The intervention was conducted in patients discharged between March and December 2014. Nurses carried out a structured telephone follow-up after hospital discharge. Normal practice was continued for the other patients.MAIN OUTCOME MEASURES: Performance indices of the predictive model. Differences in readmission and mortality rates. Results: Our model showed: Youden Index 0.360; sensitivity: 0.563; specificity 0.797. The data from the retrospective study confirm these results. We observed significant reductions in the risk of readmission or death in both intervention groups, adjusted OR= 0.38 0.28-1.50, showing the validity of the predictive model and the effectiveness of the intervention. Discussions: The UriBi LACE prediction tool has discriminatory power, with a C statistic of 0.74 for a cut-off of 6. Although the Youden index indicated a better discriminatory power for a cut-off of 3, this would imply additional follow-up of 45% of patients discharged; a J of 6 or higher would imply follow-up of 15.6% of discharged patients, which would be more feasible. Conclusions: The tool identify patients at high risk of hospital readmission or death. A structured intervention focused on improving patient knowledge about their condition, warning signs, usual medication and follow-up plan is effective. Lessons learned: We retrieve data on the variables included in the tool directly from the electronic health records. This enables us to identify a high-risk population that benefit from an intervention to strengthen the continuity of care after discharge from hospitals. Limitations: The sample size for the prospective study. We established a follow-up of 1 month, and expected to have more admissions, readmissions and deaths. This lead to a lack of accuracy in the tool, which had to be validated with data from the retrospective study.

Incidence, determinants and prognostic relevance of cardiogenic shock in patients with Takotsubo cardiomyopathy

Takotsubo cardiomyopathy (TTC) can be accompanied by various life-threatening complications, including cardiogenic shock. The exact incidence and prognostic relevance of cardiogenic shock in TTC patients has not been studied in detail. The frequency and determinants of cardiogenic shock were evaluated in 178 patients with TTC. The clinical course and treatment strategies of TTC patients with cardiogenic shock were systematically analysed. Furthermore, short and long-term mortality rates were assessed with a structured telephone follow-up. The incidence of cardiogenic shock in this large TTC population was 12.4%. Multivariable logistic regression analysis identified left ventricular ejection fraction as the only significant predictor of cardiogenic shock (odds ratio 0.80; 95% confidence interval (CI) 0.73-0.88; P<0.01). The majority of the TTC patients with cardiogenic shock were treated with catecholamine therapy (86%) and 59% received early initiated mechanical circulatory support. TTC patients with cardiogenic shock showed significantly increased 28-day mortality rates compared to patients without cardiogenic shock (28.6% vs. 4.1%; relative risk 7.05, 95% CI 2.50-19.84; P<0.01). Furthermore, cardiogenic shock patients were at ongoing increased risk of death beyond the first 28 days resulting in considerably elevated 1-year (61.9% vs. 7.4%; P<0.01) and long-term mortality rates at 3.6 years of follow-up (66.7% vs. 19%; P<0.01). Cardiogenic shock is a frequent complication in TTC patients and is associated with increased short and long-term mortality rates. Patients at risk of developing cardiogenic shock may be identified by means of a severely impaired left ventricular function.

Influence of structured telephone follow-up on patient compliance with rehabilitation after total knee arthroplasty.

IntroductionTo assess the effects of structured telephone follow-up on patient’s home-exercise compliance after total knee arthroplasty (TKA).MethodsA total of 202 elderly patients who received a unilateral TKA were enrolled in this study. The participants were randomized into two groups: the intervention group that received structured telephone follow-up after discharge and the control group that received routine health care. Pain, functional ability, quality of life, and depression survey scores were measured before and after TKA. The intergroup and intragroup differences were analyzed during the 12 months following discharge.ResultsThere were no significant differences in the sociodemographic characteristics of both groups. The mean home-exercise time and total days in the intervention group were significantly higher than those in the control group. Variable scores differed significantly between groups. Pain, functional ability, quality of life, and depression improved significantly after TKA in both groups, and the intervention group had greater improvement in mental health and active range of motion.ConclusionUndergoing a TKA can significantly reduce the patient’s pain from osteoarthritis while improving the overall physical function and quality of life. Furthermore, a structured telephone follow-up can improve patient adherence to home exercise after TKA.

​Patient and lay carer education for preventing pressure ulceration in at-risk populations

​Patient and lay carer education for preventing pressure ulceration in at-risk populations

Nurse-led telephone follow-up after total knee arthroplasty--content and the patients' views.

To generate information on how telephone follow-up consultations, structured by nursing status according to the VIPS-model, functioned after total knee arthroplasty. The objectives were to unfold the content of the telephone follow-ups according to the structure for nursing status and to explore the patients' views of the telephone follow-ups. The length of stay in hospital following total knee arthroplasty has fallen markedly, and patients now have to be responsible for their recovery from a very early stage. After discharge, patients may experience a variety of health problems. A clinical trial was conducted to evaluate the effect of telephone follow-up, and information on how the telephone follow-ups functioned is relevant for implementation into clinical practice. A qualitative design was used. One hundred and four case reports from telephone follow-up consultations and individual interviews with 10 patients formed the data material. Content analysis was used for the analysis. The content of the telephone follow-ups included dialogues relating to all key subjects for nursing status except 'culture/spirituality'. The structured Telephone follow-up was valued by total knee arthroplasties patients as representing a holistic approach and providing adequate information, counselling and support after discharge to home. Three categories were identified with regard to the patients' views: 'A means for reflection and provision of adequate information and counselling', 'Supportive' and 'Not the only resource for support and counselling'. Nursing status according to the VIPS model is a comprehensive structure to identify the need for counselling, information and support after total knee arthroplasty. The structured telephone follow-ups were valued for representing a holistic approach and providing adequate information, counselling and support after discharge to home. Conducting telephone follow-up with a holistic approach demands specialised and broad nursing experience. Postdischarge follow-up is important.

Brief Intervention and Follow-Up for Suicidal Patients With Repeat Emergency Department Visits Enhances Treatment Engagement.

We implemented an innovative, brief, easy-to-administer 2-part intervention to enhance coping and treatment engagement. The intervention consisted of safety planning and structured telephone follow-up postdischarge with 95 veterans who had 2 or more emergency department (ED) visits within 6 months for suicide-related concerns (i.e., suicide ideation or behavior). The intervention significantly increased behavioral health treatment attendance 3 months after intervention, compared with treatment attendance in the 3 months after a previous ED visit without intervention. The trend was for a decreasing hospitalization rate.

Follow-up telephone calls to patients discharged after undergoing orthopaedic surgery: double-blind, randomised controlled trial of efficacy.

To evaluate the effectiveness of a follow-up telephone call to reduce the number of issues after hospital discharge. The postdischarge period is often a time of uncertainty and risk. The decreasing length of hospital stays has increased the need for specific instructions about the postdischarge period. A telephone follow-up could be a valuable tool to fill this information gap. Double-blind, randomised controlled trial. The participants included medium or low-intensity orthopaedic patients. We implemented a structured telephone follow-up call conducted by a senior orthopaedic nurse to provide educational support to the intervention group (n=110), while the control group (n=109) received routine care after being discharged. Data were collected between September 2011-January 2012. Statistical differences between the two groups were tested using chi-square test or Wilcoxon rank sum test, as appropriate. A linear regression model was performed to investigate factors involved into postdischarge outcomes. The intervention group had a statistically significant reduction in all postdischarge problems except for pain and mobilisation; the group also had a lower chance of experiencing frequent or severe problems. The educational intervention and prior poor health had a strong correlation with problems after discharge. Patients who received a telephone follow-up call believed the information provided was valuable. This nurse-led follow-up intervention significantly contributed to solving or reducing postdischarge health problems and contributed to reduce unnecessary burden on the community health system. A nurse-led telephone follow-up is a simple, feasible and low-cost tool to improve patients' outcomes after discharge.

Educating and empowering colorectal cancer survivors

With the number of colorectal cancer (CRC) survivors increasing worldwide, there is an urgent need to identify nursing interventions that promote the improvement of the nursing care delivered, enabling autonomy and independence to CRC survivors. This article attempts to identify nursing interventions that promote the education of CRC survivors after treatment completion with curative intent. After analysing the 177 articles found, on the basis of the inclusion and exclusion criteria established, 4 articles were included in the review. The nursing interventions identified included a multimedia education programme, a structured telephone follow-up conducted by an experienced nurse specialist, and a 17-item patient-completed continuity assessment with feedback to clinical nurse specialists and actions to address the needs identified. It is essential to develop nursing research in this area, identifying nursing interventions and promoting the selfcare, autonomy, and improvement of the quality of life of CRC survivors.

Using Structured Telephone Follow‐up Assessments to Improve Suicide‐Related Adverse Event Detection

Adverse event (AE) detection and reporting practices were compared during the first phase of the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE), a suicide intervention study. Data were collected using a combination of chart reviews and structured telephone follow-up assessments postenrollment. Beyond chart reviews, structured telephone follow-up assessments identified 45% of the total AEs in our study. Notably, detection of suicide attempts significantly varied by approach with 53 (18%) detected by chart review, 173 (59%) by structured telephone follow-up assessments, and 69 (23%) marked as duplicates. Findings provide support for utilizing multiple methods for more robust AE detection in suicide research.

5 Sickle Cell Disease in the Emergency Department, Predictors of Adverse Outcomes: A Prospective Cohort Study

5 Sickle Cell Disease in the Emergency Department, Predictors of Adverse Outcomes: A Prospective Cohort Study