Acute care centers for sickle cell patients

Profile of an outstanding post-master's DNP project

Tiesa Hughes-Dillard

Clinical Issue/Practice Problem: Pain management is a primary concern for individuals with sickle cell disease (SCD). Acute vaso-occlusive episodes in patients with SCD are a leading cause of emergency department (ED) encounters and hospital admissions. Well-documented disparities include significant delay and under-treatment of SCD patients with acute pain crisis in the ED. An acute care center (ACC) staffed with SCD specialists can address these disparities.

Summary of Supporting Literature: SCD patients treated in a dedicated ACC have a 40% lower admission rate than patients treated in the ED. An expedited transfer and treatment program at an ACC unit was implemented with the goals of improving access to quality care and decreasing the hospital admission rates for SCD patients in acute pain crisis.

Project Implementation: This quality improvement project used a prospective design study of individuals with SCD >16 years of age who presented to the ED with an acute pain episode. The following key areas were identified for intervention: 1) standard criteria for direct ACC admission; 2) expedited transfer to the ACC from the ED; 3) addition of an ACC provider to extend clinic hours; and 4) establishment of consistent but individualized pain management plans across the ED and ACC. Hospital admission rates of patients with SCD were analyzed from September 2018 through August 2019.

Outcomes: There were 877 admissions to the ACC from January to July of 2019, an increase of 37% compared to the same period in 2018. Of the 877 admissions, 793 were discharged home (90.4%) as compared to 88.6 % in 2018. Time to first dose of opioids in the ACC in 2019 was 55 minutes with a decrease in the pain score of 2.62 during an average length of stay of 4.18 hours.

Clinical Implications for Practice: Expedited care and treatment through expanding access to care resulted in an increased volume of SCD patients treated in an ACC setting and decreased hospital admission rates. Allocating resources to a dedicated ACC improves throughput and overall quality of care for SCD patients in acute pain crises.