SICKLE CELL CARE- CLINICAL REDESIGN PROJECT: A MULTIDISCIPLINARY AND STANDARDIZED APPROACH TO PAIN MANAGEMENT IMPROVES QUALITY OF CARE, DECREASES LENGTH OF STAY AND COST PER CASE

Sadia K. Gazi, MD*;Astou Seye, MD;Sheikh M. Hoq, MD, MPH and Ryan O'Connell, MD, PhD, Bridgeport Hospital, Bridgeport, CT

Meeting: Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev.

Abstract number: 158

Categories: Innovations Abstracts, Quality Improvement

Keywords: ,

Background: Sickle cell disease (SCD) causes frequent painful episodes from vaso-occlusion. As hospitalists, we identified that SCD patients occupied a large number of hospital days. Undertreatment and lack of standardization of pain management was a likely reason for this. Many of these patients are opiate dependent at baseline. Varying levels of comfort amongst hospitalists in prescribing sufficient quantity of opiates and lack of established outpatient support led to frequent ER visits. Inability to recognize social issues also led to prolonged length of stay and readmission.

Purpose: We recognized that standardizing pain management for painful episodes in SCD patients would lead to faster recovery and shorter admissions. Maintaining continuity of care with the same hospitalists would prevent unnecessary workup. Establishing an outpatient medical home for this particular patient population would decrease the need to utilize the ER as a clinic. Adequate treatment in the ER would decrease unnecessary admissions. We needed involvement from staff in other key disciplines as well to ensure recognition of discharge obstacles and social barriers.

Description: The sickle cell redesign project included a treatment plan with three components: emergency room, inpatient, and outpatient treatment. Specific instructions based on each patient’s baseline opiate use was created and placed in the medical chart where it was accessible to all. In the ER, patients were treated right away and discharged home; those who did not respond were admitted to a dedicated floor of the hospital. Once inpatient, hospitalists headed a multidisciplinary team that included a palliative APRN, assistant nurse manager, care coordinator, and social worker that rounded together at bedside daily. PCA was used for deliverance of pain medication, this cancelled inebriation effect of intravenous pushes and decreased burden on nurses. Patients were transitioned to oral opiates within 48-72 hours. Social worker and care coordinator participation ensured proper follow up as outpatient and recognition of discharge obstacles and social barriers. Pharmacists and chaplains also rounded with the team on a weekly basis. A specific afternoon every week was set aside in the outpatient clinic for follow up.

Conclusions:

With this clinical redesign, hospitalists at Bridgeport Hospital were able to decrease average length of stay from 10.1 to 6.31 days. Cost per admission decreased from $8,351 to $5,812. Moreover, we saw an increase of $300,000 in contribution margin. Our data also showed that as outpatient visits were increasing, ER visits were decreasing similarly. This implicated that our patients have stopped using the emergency room inappropriately to manage their pain. The number of unique medical record numbers have also increased indicating that more sickle cell patients in the area have decided to use Bridgeport Hospital and our outpatient clinic as their primary resource for treatment.

To cite this abstract:

Gazi, SK; Seye, A; Hoq, SM; O'Connell, R . SICKLE CELL CARE- CLINICAL REDESIGN PROJECT: A MULTIDISCIPLINARY AND STANDARDIZED APPROACH TO PAIN MANAGEMENT IMPROVES QUALITY OF CARE, DECREASES LENGTH OF STAY AND COST PER CASE. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 158. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/sickle-cell-care-clinical-redesign-project-a-multidisciplinary-and-standardized-approach-to-pain-management-improves-quality-of-care-decreases-length-of-stay-and-cost-per-case/. Accessed September 19, 2019.

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