Impact of a dedicated infusion clinic for acute management of adults with sickle cell pain crisis

Abstract

Most adults with sickle cell disease (SCD) receive care for their acute painful episodes in an emergency department (ED) setting. The purpose of this article is to describe the impact of opening a dedicated treatment center for adults with SCD [Sickle Cell Infusion Clinic (SCIC)] on patient outcomes and on hospital discharges for SCD. Descriptive data including demographics, time to first dose of narcotic, and pain scores were collected on patients presenting to the SCIC and ED. Maryland hospital discharge data were obtained from the Maryland Health Services Cost Review Commission. Analyses were conducted using T tests, χ(2) tests, and simple generalized estimating equation regression models accounting for the clustered nature of observations, as appropriate. There were 3,874 visits to the SCIC by 361 unique patients; 85% of those visits resulted in the patient being sent home. During the same time period, there were 3,408 visits to the ED by 558 unique patients with SCD. The overall admission rate from the ED for these patients was 35.9% but decreased significantly over the time period with a rate of 20% in December 2011. There was a significant decrease in readmissions over time for the entire Baltimore Metro area with the likelihood of readmission decreasing by 7% over time. The SCIC model provides adults with SCD access to high quality care that decreases the need for hospital admission. Further research needs to be done to evaluate the cost effectiveness of this model.

Figure 1. Change in Admission rate for ED with Comparison SCIC data

Solid line reflects the percent of patients that were admitted to the hospital from the ED over the study time period. The dotted line represents the percent of patients that were either directly admitted or transferred to the ED from the SCIC for ongoing treatment of VOC.

Figure 2. Regional Trends in MD SCD Hospital Discharges

Trends in hospital admissions from 2007–2011 by region. Region 1: Baltimore City, Region 2: Within 90 miles of Baltimore Region 3: More than 90 miles from Baltimore

Figure 3. Regional Trends in MD SCD Readmission Rates

Trends in hospital 30 day readmissions from 2007–2011 by region. Region 1: Baltimore City, Region 2: Within 90 miles of Baltimore Region 3: More than 90 miles from Baltimore