Sickle cell vasoocclusive pain crises (VOC) are associated with considerable morbidity and mortality, prolonged hospital stays and significant resource utilization. Suboptimal treatment of pain during VOC is associated with increased morbidity and mortality. Standardized order sets have been shown to reduce physician error and create efficiency. There are no current evidence based treatment guidelines for VOC.
We hoped to standardize treatment for vasoocclusive pain crises (VOC) by having all patients admitted for a pain crisis cared for by the same hospitalist service with consistent treatment protocols and an accessible hematology consult service. We aimed to reduce length of hospital stay (LOS) for patients with VOC by optimizing treatment protocols and improving intragroup and hospitalisthematology communication. We measured complications and resource utilization as well as measures of patient satisfaction and outcomes.
This is a retrospective and prospective cohort study evaluating admissions and emergency department visits at the University of North Carolina Hospitals in Chapel Hill, North Carolina. Since assuming care of all VOC admissions at UNC, we have had multiple phases. Initially, all patients with VOC were admitted to one team of hospitalist physicians and one ward. Next, Hospital Medicine Program faculty agreed on protocol of care and preferential use of Patient Controlled Analgesia (PCA) with frequent adjustment to achieve pain control as early as possible in hospitalization. A computerized Physician Order Entry order set was created and made available with emphasis on use of PCA. PCA settings used during prior hospitalizations were then recorded in discharge summaries for patients and faculty encouraged to utilizing these PCA settings for future admissions. We hypothesized that through this intervention, patients with VOC would require fewer resources both during individual hospitalizations and globally. We used the following metrics of care: average LOS, readmission rate in 7 and 30 days, admissions per patient in a 6 month interval, ED visits per patient per year, Acute Chest Syndrome episodes, transfusions of PRBCs, naloxone administration, total charge per case, and PCA usage.
For the six 6 months prior to this intervention (1/096/09) LOS was 6.28 days and for the most recent six month period (1/116/11) the LOS for VOC was 4.61 days. PCA usage during those time periods has increased from 60% to 96.2%. No other metrics showed significant differences. Sickle cell VOCs are safely and effectively treated with a consistent and comprehensive pain management protocol on a hospitalist service.
To cite this abstract:Liles E, Kirsch J, Harris M, Gilchrist M, Adem M. Hospitalist Management of Vasoocclusive Pain Crisis. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97718. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/hospitalist-management-of-vasoocclusive-pain-crisis/. Accessed September 19, 2019.