Sickle cell disease (SCD) patients are overre‐presented in emergency department and inpatient settings, requiring more than $2 billion annually for hospitalization. Average length of stay (LOS) is 5.3 days, whereas 14‐day readmission rates can be as high as 30%. We describe a new service aimed at improving SCD patient outcomes in the hospital.
A 4‐bed specialized sickle cell service (SCS) was created in March 2010 to promote better comanagement for the hospitalist team and sickle cell team (SCT). The service consists of a hospitalist attending and a provider from the SCT, with no residents. SCS members see all SCD patients in the hospital but write orders only for patients on the SCS, which at any given time includes a subset medicine in patients with SCD. Patients not admitted to this service serve as concurrent controls. We collected data on all SCD‐related hospital discharges from January to November 2010. Here we describe characteristics and comparison data on LOS, total charges, and hospital read‐mission rates, comparing the new SCS and the general medical services (usual care). Patient‐level analyses were conducted using t tests. Discharge‐level analyses were conducted using generalized estimating equations to account for multiple observations on individual patients.
In total, 188 individuals with SCD were admitted to the hospital during the study period, accounting for 405 total admissions, 79 of these on the SCS (24%). Average age was 34.4 years, and 38% were male. The difference in LOS was not statistically different for those admitted to the SCS [6.6 days (5.5, 7.6 days)] versus general medical services [5.9 days (5.1, 6.8 days)]; average charges per admission were not significantly different. Twenty‐three percent of the 188 patients (n = 43) had at least 1 readmission within 30 days of discharge. On average, patients with at least one 30‐day readmission spent significantly more days in the hospital during the time period than those without a 30‐day readmission [34.1 days (25.2, 42.9 days) vs. 7.4 days (5.86, 9.0 days)]. We found that the odds of experiencing a readmission within 14 days were 65% lower for patients discharged from the sickle cell service than those discharged from the general medical services (adjusted OR, 0.35; 95% CI, 0.13–0.92; P = 0.032). There was no statistically significant difference in 30‐day readmission rate between services (adjusted OR, 0.83; 95% CI, 0.39–1.8; P = 0.63).
In this pilot study, we found that patients cared for by a SCS were significantly less likely to be readmitted within 14 days of discharge; other metrics were not significantly affected. We intend to continue and refine this clinical care model.
P. Ranasinghe ‐ Johns Hopkins School of Medicine, employment; C. Haywood, Jr. ‐ Johns Hopkins School of Medicine, employment; S. Lanzkron ‐ Johns Hopkins School of Medicine, employment
To cite this abstract:Ranasinghe P, Haywood C, Lanzkron S, Brotman D. Readmission Rates on a Sickle Cell Service Run by Hospitalists and Sickle Cell Specialists: A Quality Improvement Pilot Project. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 98. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/readmission-rates-on-a-sickle-cell-service-run-by-hospitalists-and-sickle-cell-specialists-a-quality-improvement-pilot-project/. Accessed March 30, 2020.