Multi‐modal intervention and prospective implementation of standardized sickle cell pain admission orders reduces 30‐day readmission rate

Frei-Jones, Msci Melissa J.; Field, Joshua J.; DeBaun, Mph Michael R.

doi:10.1002/pbc.22048

Cited by 29 publications

(19 citation statements)

References 9 publications

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“…However, to date there have been few studies to validate this marker and debate remains as to its value. One single-institution study identified co-morbid asthma, oxygen within 24 hr of discharge, disease severity and lack of clinic follow-up within 30 days as factors associated with higher risk of readmission, however, their study design did not allow for an actual estimate of readmission rates [6,8]. A 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 age 1–9 and 23.4% for patients ages 10–17); however, it did not examine factors other than age associated with readmission [9].…”

Section: Introductionmentioning

confidence: 99%

“…Corticosteroids have also been implicated in higher sickle cell readmission rates, specifically after a diagnosis of acute chest syndrome [10,11], although this has not been shown in all studies [12]. Use of a standardized sickle cell pain plan has been show to reduce readmission rates [8,13]. Finally, work in other diseases has identified African-American race, public insurance, neighborhood conditions, including high measures of poverty, patient complexity, disease severity, and weekend discharge as factors leading to greater risk of readmission with comprehensive discharge planning being shown to reduce readmissions rates [13–16].…”

Section: Introductionmentioning

confidence: 99%

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Thirty‐day readmission rates following hospitalization for pediatric sickle cell crisis at freestanding children's hospitals: Risk factors and hospital variation

Sobota

Graham

Neufeld

et al. 2011

Pediatric Blood & Cancer

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Background Readmission within 30 days after hospitalization for sickle cell crisis was developed by The National Association of Children’s Hospitals (NACHRI) to improve hospital quality, however, there have been few studies validating this. Procedure We performed a retrospective examination of 12,104 hospitalizations for sickle crisis from July 1, 2006 and December 31, 2008 at 33 freestanding children’s hospitals in the Pediatric Health Information System (PHIS) database. Hospitalizations met NACHRI criteria; inpatient admission, APR DRG code 662, age < 18, discharge home, and length of stay within 2 SD of the mean. We describe 30-day readmission rates, identify factors associated with readmission accounting for patient-level clustering and compare unadjusted versus adjusted variation in readmission rates. Results We identified 4,762 patients with 12,104 qualifying hospitalizations (1–30 per patient). Two thousand seventy-four (17%) hospitalizations resulted in a readmission within 30 days. Significant factors associated with readmission were age (OR 1.06/year, P < 0.0001), inpatient use of steroids (OR 1.48, P = 0.01) admission for pain without other sickle complications (OR 1.52, P < 0.0001) and simple transfusion (OR 0.58, P = 0.0002). There was significant variation in readmission rates between hospitals, even after accounting for clustering by patient and hospital case mix. Conclusions In a sample of free-standing children’s hospitals, 17% of hospitalizations for sickle cell crisis result in readmission within 30 days. Older patients, those treated with steroids and those admitted for pain are more likely to be readmitted; simple transfusion is protective. Even after adjusting for case mix substantial hospital variation remains, but specific hospital to hospital comparisons differ depending on the exact methods used.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Thirty‐day readmission rates following hospitalization for pediatric sickle cell crisis at freestanding children's hospitals: Risk factors and hospital variation

Sobota

Graham

Neufeld

et al. 2011

Pediatric Blood & Cancer

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“…15 Despite the development of national guidelines for the management of SCD pain and other complications, 1,16 clinical practice and rates of acceptable care remain variable, 17,18 with patients with SCD experiencing high inpatient and emergency department readmission rates. 19-21 …”

Section: Introductionmentioning

confidence: 99%

Chart Card: Feasibility of a Tool for Improving Emergency Department Care in Sickle Cell Disease

Neumayr¹,

Pringle²,

Giles³

et al. 2010

Journal of the National Medical Association

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Background Patients with sickle cell disease (SCD) are concerned with emergency department care, including time to treatment and staff attitudes and knowledge. Providers are concerned about rapid access to patient information and SCD treatment protocols. A software application that stores and retrieves encrypted personal medical information on a plastic credit card–sized Chart Card was designed. Objective To determine the applicability and feasibility of the Chart Card on patient satisfaction with emergency department care and provider accessibility to patient information and care protocols. Methods One-half of 44 adults (aged ~18 years) and 50 children with SCD were randomized to either the Chart Card or usual care. Patient satisfaction was surveyed pre and post implementation of the Chart Card program, and emergency department staff was surveyed about familiarity with SCD treatment protocols. Results Fifty-two percent of patients were female (mean age, 18.8 ± 15.6); 61% had SCD SS. Adults visited an emergency department 4.2 ± 4.0 times in the year prior to enrollment vs 2.7 ± 3.7 (p = .06) visits for children, most commonly for pain. Patient emergency department care ratings of very good or excellent increased from 47% to 66% (p < .05), and ratings of staff knowledge improved. Qualitative data reflected positive comments about patient and staff experiences with the Chart Card. Conclusion Patient satisfaction with emergency department care and efficacy in health care increased post Chart Card implementation. Providers valued immediate access to patient information and SCD treatment guidelines. The technology has potential for application in the treatment of other illnesses in other settings.

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“…Several factors associated with inadequate analgesia have been described: assumptions of health care practitioners about possible drug-seeking behaviors; frequent ED visits by some patients; and predominance of African-American race. In fact, aggressive pain treatment administered according to specific clinical practice guidelines [24][25][26][27] resulted in significant decrease in waiting time for analgesia, analgesic dosing, increase use of validated pain scale, 28 and reduction of 30-day readmission rate 29 in the United States. Inadequate analgesia for SCD patients and long time to analgesics provision for pain in the ED 20 have been recently demonstrated even in countries with long-established experience in the management of SCD patients, suggesting that addressing these topics requires long-term interventions.…”

Section: Discussionmentioning

confidence: 99%

The Management of Sickle Cell Pain in the Emergency Department

Colombatti²,

Cirigliano³

et al. 2013

The Clinical Journal of Pain

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Multi‐modal intervention and prospective implementation of standardized sickle cell pain admission orders reduces 30‐day readmission rate

Cited by 29 publications

References 9 publications

Thirty‐day readmission rates following hospitalization for pediatric sickle cell crisis at freestanding children's hospitals: Risk factors and hospital variation

Thirty‐day readmission rates following hospitalization for pediatric sickle cell crisis at freestanding children's hospitals: Risk factors and hospital variation

Chart Card: Feasibility of a Tool for Improving Emergency Department Care in Sickle Cell Disease

The Management of Sickle Cell Pain in the Emergency Department

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