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New Strategies for Treating Pediatric Sickle Cell Disease

February 4, 2020
A recent 5-year study of more than 200 children showed reduced pain and fewer hospital admissions.

A PPM Brief with Farzana Pashankar, MD, MRCP

In a 5-year study of more than 200 children with sickle cell disease (SCD), “simple and likely reproducible” interventions lowered pain, hospital admissions, length of hospital stays, and readmission rates at Yale New Haven Children’s Hospital among patients experiencing vaso-occlusive crisis (VOC).1 The researchers established multiple quality improvement initiatives, including:

  • order sets for hospital admissions in patients’ medical records
  • daily schedules and guidelines for hospitalized patients
  • patient education on non-drug pain management strategies, SCD, and coping techniques, and
  • individual home action plans for pain management, which were also available in patients’ records.

Originally, results were disappointing: “After the first year of interventions, our analyses pre- and post-interventions showed no change in admissions or hospital days,” co-author Farzana Pashankar, MD, MRCP, associate professor of pediatrics at Yale School of Medicine, told PPM. “This was a surprise, and it made us go back to the drawing board.”

After further analyses, “We found that a small subgroup of patients (only 6% of the total cohort)” were admitted to the hospital four or more times a year. These high-use patients “accounted for almost 61% of total admissions and hospital days,” Dr. Pashankar explained. Identified key risk factors were older age and underlying mental health conditions.

High-use patients began receiving extra support, which included pain plan reviews and updates every 1 to 2 months, as well as information about and prescriptions for hydroxyurea. High-use patients also met with a social worker or psychologist at every visit, during which biofeedback techniques for relaxation and pain management were taught. The team also continuously monitored and supported the cohort to identify patients at risk of becoming high risk, and introduced a pain order set in the pediatric emergency department.

By the time the study concluded, the percentage of SCD patients with VOC admitted to the hospital dropped from 25.4 to 13.3; number of hospital admissions decreased by nearly 55%, and the total number of days that patients spent in the hospital plummeted from 59.6 to 23.2 days a month, a 61% decrease. Length of hospital stays declined from nearly 5 to just under 4 days, on average. Moreover, within 19 months of program's start, the 30-day readmission rate had dipped from 33.9 to 19.4%. Finally, the number of high-use patients more than halved, from 6% to less than 3%.

Dr. Pashankar's team is now looking to see if ER visits among the group decreased as well. "As all patients had a home pain plan as part of this project, we want to see if the number of visits to the emergency room decreased thanks to the interventions," she said.

See also a related case on the use of oxygen for SCD crises.

Last updated on: February 5, 2020
Continue Reading:
Using L-glutamine for Sickle Cell Disease Crises
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