Sickle Cell Quality Improvement Team: Improving the Quality, Consistency, and Coordination of Care for Patients with Sickle Cell Anemia

1Medicine, Cedars‐Sinai Medical Center, and University of California‐Los Angeles, Los Angeles, CA
2Medicine, Cedars‐Sinai Medical Center, Los Angeles, CA
3Nursing, Cedars‐Sinai Medical Center, and University of California‐Los Angeles, Los Angeles, CA

Meeting: Hospital Medicine 2008, April 3-5, San Diego, Calif.

Abstract number: 102

Background:

Sickle cell anemia is a chronic disease punctuated by acute pain crises. Up to 60% of patients with sickle cell anemia will have an episode of severe pain in a given year, making their care the collective job of nurses, PMDs, hematologists, and hospital‐ists. However, little information exists to guide optimal inpatient treatment. Further, significant variation exists across providers on how crises are managed, and short‐term goals, poor coordination of care, and lack of communication likely result in higher‐than‐necessary rates of opiate dependence, length of stay, and readmission rates over time.

Purpose:

To design the optimal approach for treating sickle cell crises by eliciting input from a wide spectrum of health care providers, with the goal of improving the consistency, quality, and coordination of care for sickle cell patients.

Table 1. Outcomes: 6‐Month Rollout

Description:

We convened a multidisciplinary team consisting of doctors from multiple specialties, nurses, pharmacists, ER personnel, and social workers to establish fair and best practices. We created an order set for physicians and a “guidelines” educational document for patients. We built an electronic team list with an editable memo section that contained pertinent psychosocial and clinical information, and this information was accessible by any caregiver through the hospital EMR. A multitiered marketing campaign was driven by our team leaders to enhance visibility throughout the hospital. One of our team leaders met with virtually every patient (98%) to review the guidelines and order set, answer questions, and intervene with the patient's PMD or hematologist to achieve compliance. Data from our 6‐month rollout were compared with data from the same 6‐month period 1 year prior, based on a series of relevant DRGs.

Conclusions:

Given the complexity of patient care in today's health care environment, a balanced participation of physicians, nurses, case managers, pharmacists, ER, and patients is absolutely essential in order to establish a consensus regarding best practices. Standardized order sets are a necessary but not sufficient component to lead change. Patient buy‐in and passionate, capable, and committed project champions proved to be absolutely essential for achieving successful and sustainable results. Special attention must be paid when tackling potentially explosive issues related to chronic pain syndrome, race, or socioeconomic disparities.

Figure 1. Electron micrograph of a normal rbc (left) and a sickled RBC (right).

Author Disclosure:

B. Rosen, none; D. Cohen, none; S. Rome, none.

To cite this abstract:

Rosen B, Cohen D, Rome S. Sickle Cell Quality Improvement Team: Improving the Quality, Consistency, and Coordination of Care for Patients with Sickle Cell Anemia. Abstract published at Hospital Medicine 2008, April 3-5, San Diego, Calif. Abstract 102. Journal of Hospital Medicine. 2008; 3 (suppl 1). https://www.shmabstracts.com/abstract/sickle-cell-quality-improvement-team-improving-the-quality-consistency-and-coordination-of-care-for-patients-with-sickle-cell-anemia/. Accessed September 16, 2019.

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