Emergency Department (ED), ED Observation, Day Hospital, and Hospital Admissions for Adults with Sickle Cell Disease
| Autor: | Susan G. Silva, David M. Cline, Paula Tanabe, Caroline E. Freiermuth, Victoria L. Thornton |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Adult
medicine.medical_specialty Anemia lcsh:Medicine Context (language use) Anemia Sickle Cell Disease Patient Readmission 03 medical and health sciences 0302 clinical medicine Acute care medicine Humans Prospective Studies Vaso-occlusive crisis sickle cell pain sickle cell disease hospital admission emergency admissions Prospective cohort study Original Research business.industry lcsh:R lcsh:Medical emergencies. Critical care. Intensive care. First aid 030208 emergency & critical care medicine General Medicine Emergency department lcsh:RC86-88.9 medicine.disease Quality Improvement Health Outcomes Hospitals Sickle cell anemia Hospitalization 030220 oncology & carcinogenesis Cohort Emergency medicine Emergency Medicine Guideline Adherence Emergency Service Hospital business |
| Zdroj: | Cline, David M.; Silva, Susan; Freiermuth, Caroline E.; Thornton, Victoria; & Tanabe, Paula. (2018). Emergency Department (ED), ED Observation, Day Hospital, and Hospital Admissions for Adults with Sickle Cell Disease. Western Journal of Emergency Medicine, 19(2). doi: 10.5811/westjem.2017.9.35422. Retrieved from: http://www.escholarship.org/uc/item/69n4s9c4 Western Journal of Emergency Medicine, Vol 19, Iss 2 (2018) Western Journal of Emergency Medicine |
| DOI: | 10.5811/westjem.2017.9.35422. |
| Popis: | Introduction: Use of alternative venues to manage uncomplicated vaso-occlusive crisis (VOC), such as a day hospital (DH) or ED observation unit, for patients with sickle cell anemia, may significantly reduce admission rates, which may subsequently reduce 30-day readmission rates. Methods: In the context of a two-institution quality improvement project to implement best practices for management of patients with sickle cell disease (SCD) VOC, we prospectively compared acute care encounters for utilization of 1) emergency department (ED); 2) ED observation unit; 3) DH, and 4) hospital admission, of two different patient cohorts with SCD presenting to our two study sites. Using a representative sample of patients from each institution, we also tabulated SCD patient visits or admissions to outside hospitals within 20 miles of the patients’ home institutions. Results: Over 30 months 427 patients (297 at Site 1 and 130 at Site 2) initiated 4,740 institutional visits, totaling 6,627 different acute care encounters, including combinations of encounters. The range of encounters varied from a low of 0 (203 of 500 patients [40.6%] at Site 1; 65 of 195 patients [33.3%] at Site 2), and a high of 152 (5/month) acute care encounters for one patient at Site 2. Patients at Site 2 were more likely to be admitted to the hospital during the study period (88.4% vs. 74.4%, p=0.0011) and have an ED visit (96.9% vs. 85.5%, p=0.0002). DH was used more frequently at Site 1 (1.207 encounters for 297 patients at Site 1, vs. 199 encounters for 130 patients at Site 2), and ED observation was used at Site 1 only. Thirty-five percent of patients visited hospitals outside their home academic center. Conclusion: In this 30-month assessment of two sickle cell cohorts, healthcare utilization varied dramatically between individual patients. One cohort had more hospital admissions and ED encounters, while the other cohort had more day hospital encounters and used a sickle cell disease observation VOC protocol. One-third of patients sampled visited hospitals for acute care outside of their care providers’ institutions. |
| Databáze: | OpenAIRE |
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